Eosinophil: A New Circulating Biomarker for Risk of Poor Outcome in Stroke Patients Undergoing Mechanical Thrombectomy

Abstract

Objective

Acute ischemic stroke (AIS), caused by occlusion of large vessel, is a serious life-threatening disease. This study aimed to comprehensively investigate the association of 14 common and readily available circulating biomarkers with the 90-day modified Rankin Scale (mRS) score in patients undergoing mechanical thrombectomy (MT).

Methods

This study included patients with anterior circulation large vessel occlusive stroke treated with MT from 05/2017 to 12/2021. Baseline comparisons of poor outcome were performed among enrolled patients. Factors that may be associated with the mRS score were assessed using correlation analysis. Univariate and multivariate logistic regression analyses were used to evaluate the predictive value of circulating biomarkers and poor outcome.

Results

The mRS score has a strong correlation with neutrophil to lymphocyte ratio (NLR) and eosinophil levels (all r_s>0.4 in absolute value and all P<0.001) in addition to a high correlation with National Institute of Health Stroke Scale (NIHSS) score (r_s=0.40, P<0.001). There was also a high correlation between NLR and eosinophil (r_s=−0.58, P<0.001). In the multivariate regression analysis, only neutrophil (adjusted OR=1.301, 95% CI: 1.155−1.465, P<0.001), eosinophil (adjusted OR<0.001, 95% CI: <0.001−0.016, P<0.001), and NLR (adjusted OR=1.158, 95% CI: 1.082−1.241, P<0.001) were independently associated with poor outcome.

Conclusion

This study evaluated a series of circulating biomarkers and found that neutrophil, eosinophil, and NLR independently predicted poor outcome after MT in AIS patients. There was a significant negative correlation between eosinophil and NLR levels.

Keywords:

• acute ischemic stroke
• mechanical thrombectomy
• biomarker
• eosinophil
• poor outcome

Abbreviations

AIS, acute ischemic stroke; MT, mechanical thrombectomy; NIHSS, the National Institute of Health Stroke Scale; NLR, neutrophil to lymphocyte ratio; mTICI, modified thrombolysis in cerebral infarction; PT, prothrombin time; APTT, activated partial thromboplastin time; ASITN/SIR, American society of interventional and therapeutic; neuroradiology/society of interventional radiology; ASPECTS, Alberta Stroke Program Early Computed Tomography Score; ICA, internal carotid artery; MCA, middle cerebral artery; SD, standard deviation; IQR, interquartile range; mRS, modified rankin scale.

Statements and Declarations

This study has been approved by the Institutional Ethics Review Board of the Second Hospital of Soochow University (ethical review decision number: JD-HG-2022-11) and the informed consent was exempt. We followed the Declaration of Helsinki in conducting our research and kept patient data strictly confidential.

Acknowledgments

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

The work has been supported in part by the grant from the Suzhou Science and Technology Bureau Medical-Industrial Collaborative Innovation Research Project (SLJ2021014) and the Suzhou Medical and Health Science and Technology Innovation (SKY2022160).