Eosinophil-to-Monocyte Ratio is a Potential Predictor of Prognosis in Acute Ischemic Stroke Patients After Intravenous Thrombolysis

Abstract

Background

Eosinophil and monocyte have been demonstrated separately to be independent predictors of acute ischemic stroke (AIS). This study aimed to evaluate the association between eosinophil-to-monocyte ratio (EMR) and 3-month clinical outcome after treatment with recombinant tissue plasminogen activator (rt-PA) for AIS patients. Simultaneously, we made a simple comparison with other prognostic indicators, such as 24h neutrophil-to-lymphocyte ratio (NLR) and 24h platelet-to-lymphocyte ratio (PLR) to investigate the prognostic value of EMR.

Methods and Results

A total of 280 AIS patients receiving intravenous thrombolysis were retrospectively recruited for this study. Complete blood count evaluations for EMR were conducted on 24 hours admission. The poor outcome at 3-month was defined as the modified Rankin Scale (mRS) of 3–6 and the mRS score for death was 6. The EMR levels in patients with AIS were lower than those in the healthy controls and showed a negative correlation with the NIHSS score. At the 3-month follow-up, multivariate logistic regression analysis indicated an association among EMR, poor outcome and mortality. In addition, EMR had a higher predictive ability than popular biomarkers like NLR and PLR for 3-month mortality.

Conclusion

The lower levels of EMR were independently associated with poor outcome and dead status in AIS patients.

Keywords:

• acute ischemic stroke
• eosinophil-to-monocyte ratio
• intravenous thrombolysis
• treatment outcome
• modified rankin scale

Acknowledgments

We sincerely thank the participating hospitals, AIS patients, their families and colleagues who have provided valuable suggestions for this study. Yueping Chen, Junli Ren, and Naiping Yang are co-first authors of this study.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author on reasonable request.

Ethics Approval and Consent to Participate

The study was approved by the Ethics Committee of the Third Affiliated Hospital of Wenzhou Medical University and was performed in accordance with the Declaration of Helsinki. All subjects signed a written informed consent form.

Consent for Publication

Not applicable.

Author Contributions

Conceptualization and design, SZ and GC; Methodology, SZ, GC, YC and JR; Software, JR and NY; Validation, JR and NY; Formal Analysis, JR, NY, HH and XH; Investigation, SZ and GC; Resources, SZ and GC; Data Curation, YC, JR, NY, HH, XH, FS, TZ, XZ, WP, JH and BG; Writing-Original Draft Preparation, YC, JR, NY; Writing-Review & Editing, SZ, GC, YC, JR, NY, HH, XH, FS, TZ, XZ, WP, JH and BG; Visualization, YC, JR, and NY; Supervision, SZ and GC; Project Administration, SZ and GC. All authors contributed to data analysis, drafting or revising the article, have agreed on the journal to which the article will be submitted, gave final approval for the version to be published, and agreed to be accountable for all aspects of the work.

Disclosure

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.