Correlation of Peripheral Blood Inflammatory Indicators to Prognosis After Intravenous Thrombolysis in Acute Ischemic Stroke: A Retrospective Study

Figures & data

Table 1 Baseline Characteristics of AIS Patients Received Early Intravenous Thrombolysis Treatment

Variables	Total (n=204)	Good Outcome (n=162)	Poor Outcome (n=42)	P-value
Age, mean (±SD)	69.1±12.3	66.9±11.8	77.4±10.5	<0.001
Gender, n (%)				0.073
Male	131 (64.2)	109 (67.2)	22 (52.3)
Female	73 (35.7)	53 (32.7)	20 (47.6)
NLR, median [IQR]	2.5 [1.8, 3.7]	2.4 [1.8, 3.5]	3.5 [2.3, 5.8]	0.004
LMR, median [IQR]	3.5 [2.3, 4.6]	3.7 [2.5, 4.8]	2.6 [1.6, 3.5]	<0.001
CRP, median [IQR]	0.8 [0.5, 3.2]	0.7 [0.5, 2.4]	1.8 [0.8, 10.6]	<0.001
C-NLR, median [IQR]	0.4 [0.2, 1.3]	0.4 [0.2, 1.0]	0.6 [0.2, 3.1]	0.046
C-LMR, median [IQR]	3.3 [2.0, 10.3]	3.0 [2.0, 9.1]	5.4 [2.40, 23.1]	0.031
Vascular risk factors
Cerebral hemorrhage, n (%)				0.901
Yes	9 (4.4)	7 (4.3)	2 (4.7)
No	195 (95.5)	155 (95.6)	40 (95.2)
Transient ischemic attack, n (%)				0.338
Yes	56 (27.4)	42 (25.9)	14 (33.3)
No	148 (72.5)	120 (74.0)	28 (66.6)
Atrial fibrillation, n (%)				<0.001
Yes	26 (12.7)	14 (8.6)	12 (28.5)
No	178 (87.2)	148 (91.3)	30 (71.4)
Coronary heart disease, n (%)				0.002
Yes	43 (21.0)	27 (16.6)	16 (38.0)
No	161 (78.9)	135 (83.3)	26 (61.9)
Hypertension, n (%)				0.503
Yes	147 (72.0)	115 (70.9)	32 (76.1)
No	57 (27.9)	47 (29.0)	10 (23.8)
Diabetes mellitus, n (%)				0.022
Yes	85 (41.6)	61 (37.6)	24 (57.1)
No	119 (58.3)	101 (62.3)	18 (42.8)
Hyperlipemia, n (%)				0.003
Yes	141 (69.1)	120 (74.1)	21 (50.0)
No	63 (30.8)	42 (25.9)	21 (50.0)
Myocardial infarction, n (%)				0.279
Yes	12 (5.8)	11 (6.8)	1 (2.3)
No	192 (94.1)	151 (93.2)	41 (97.6)
Renal insufficiency, n (%)				0.147
Yes	14 (6.8)	9 (5.5)	5 (11.9)
No	190 (93.1)	153 (94.4)	37 (88.0)
Medication use history
Anti-hypertension, n (%)				0.503
Yes	147 (72.1)	115 (70.9)	32 (76.2)
No	57 (27.9)	47 (29.0)	10 (23.8)
Hypoglycemic drugs, n (%)				0.050
Yes	80 (39.2)	58 (35.8)	22 (52.4)
No	124 (60.7)	104 (64.1)	20 (47.6)
Anti-platelet, n (%)				0.113
Yes	155 (75.9)	127 (78.3)	28 (66.6)
No	49 (24.0)	35 (21.6)	14 (33.3)
Statins, n (%)				0.012
Yes	160 (78.4)	133 (82.0)	27 (64.2)
No	44 (21.5)	29 (17.9)	15 (35.7)
Personal History
Smoking history, n (%)				0.481
Yes	42 (20.5)	35 (21.6)	7 (16.6)
No	162 (79.4)	127 (78.3)	35 (83.3)
Drinking history, n (%)				0.371
Yes	60 (29.4)	50 (30.8)	10 (23.8)
No	144 (70.5)	112 (69.1)	32 (76.1)
Clinical indicators
SBP, median [IQR]	141.4 [132.3, 150.3]	142.1 [133.0, 150.6]	135.4 [127.9, 144.6]	0.033
DBP, mean (±SD)	80.6±9.2	81.1±9.3	78.6±8.6	0.117
TC, mean (±SD)	4.3±1.1	4.4±1.1	4.1±0.9	0.064
TG, median [IQR]	1.3 [1.0, 1.7]	1.2 [1.0, 1.8]	1.3 [0.9, 1.6]	0.909
HDL, median [IQR]	1.3 [1.0, 1.4]	1.2 [1.1, 1.5]	1.2 [1.0, 1.4]	0.131
LDL, mean (±SD)	2.6±0.9	2.7±0.9	2.4±0.7	0.112
Stroke assessment
A-NIHSS, median [IQR]	4.0 [2.0, 7.0]	3.0 [2.0, 5.0]	12.0 [7.0, 16.0]	<0.001
I-NIHSS, median [IQR]	2.0 [1.0, 6.0]	2.0 [1.0, 4.0]	11.0 [7.0, 15.0]	<0.001
A-mRS, median [IQR]	3.0 [1.0, 4.0]	2.0 [1.0, 3.0]	4.0 [4.0, 5.0]	<0.001
I-mRS, median [IQR]	1.0 [1.0, 3.0]	1.0 [1.0, 2.0]	4.0 [4.0, 5.0]	<0.001

Notes: P<0.05 was considered statistically significant.

Abbreviations: NLR, neutrophil-to-lymphocyte ratio; LMR, lymphocyte-to-monocyte ratio; CRP, high sensitivity C-reactive protein; C-NLR: CRP/neutrophil-to-lymphocyte ratio; C-LMR: CRP×lymphocyte-to-monocyte ratio; SD:standard deviation; IQR: Interquartile Range; SBP, systolic blood pressure; DBP, systolic blood pressure; TC, total cholesterol; TG, triglycerides; HDL, high density lipoprotein; LDL, low density lipoprotein; NIHSS, National Institutes of Health Stroke Scale; A-N, National Institutes of Health Stroke Scale on admission; I-N, National Institutes of Health Stroke Scale after intravenous thrombolytic therapy; mRS, modified Rankin scale; A-mRS, modified Rankin scale on admission; I-mRS, modified Rankin scale after intravenous thrombolytic therapy.

Figure 1 Flow chart.

Abbreviations: AIS, acute ischemic stroke; mRS, modified Rankin scale.

Figure 2 Violet plot of C-NLR and C-LMR.

Abbreviations: C-NLR, CRP/neutrophil-to-lymphocyte ratio; C-LMR, CRP×lymphocyte-to-monocyte ratio.

Table 2 Univariate and Multivariate Logistic Regression of NLR, LMR, CRP, C-NLR, C-LMR

	Univariate Analysis		*Multivariate Analysis
	OR.95% CI	P_value	OR.95% CI	P_value
NLR	1.185(1.060~1.324)	0.003	1.022(0.877~1.191)	0.784
LMR	0.673(0.524~0.864)	0.002	0.935(0.588~1.488)	0.777
CRP	1.042(1.013~1.071)	0.004	1.047(0.996~1.101)	0.074
C-NLR	1.145(1.034~1.268)	0.009	1.586(1.098~2.291)	0.014
C-LMR	1.020(1.006~1.034)	0.004	1.099(1.025~1.179)	0.008

Notes: P<0.05 was considered statistically significant. *Variables adjusted for multivariate regression analysis are as follows: age, atrial fibrillation, coronary heart disease, diabetes mellitus, hyperlipidemia, hypoglycemic drugs, Statins, systolic blood pressure, NIHSS on admission; NIHSS after intravenous thrombolytic therapy; mRS on admission; mRS after intravenous thrombolytic therapy.

Abbreviations: NLR, neutrophil-to-lymphocyte ratio; LMR, lymphocyte-to-monocyte ratio; CRP, high sensitivity C-reactive protein; C-NLR: CRP/neutrophil-to-lymphocyte ratio; C-LMR: CRP×lymphocyte-to-monocyte ratio; OR, odd ratio; 95% CI, 95% confidence interval.

Figure 3 Univariate and multivariate logistic regression analysis forest plots for NLR, LMR, CRP, C-NLR, C-LMR.

Notes: 95% Confidence Interval of univariate analysis: NLR, 1.060~1.324; LMR, 0.524~0.864; CRP, 1.013~1.071; C-NLR, 1.034~1.268; C-LMR, 1.006~1.034. 95% Confidence Interval of multivariate analysis: NLR, 0.877~1.191; LMR, 0.588~1.488; CRP, 0.996~1.101; C-NLR, 1.098~2.291; C-LMR, 1.025~1.179.

Abbreviations: NLR, neutrophil-to-lymphocyte ratio; LMR, lymphocyte-to-monocyte ratio; CRP, high sensitivity C-reactive protein; C-NLR, CRP/neutrophil-to-lymphocyte ratio; C-LMR, CRP×lymphocyte-to-monocyte ratio.

Figure 4 Receiver operating characteristic(ROC) curve of C-NLR, C-LMR.

Abbreviations: C-NLR, CRP/neutrophil-to-lymphocyte ratio; C-LMR, CRP×lymphocyte-to-monocyte ratio.

Figure 5 Kaplan-Meier survival curve of C-NLR and C-LMR.

Notes: log-rank<0.05 was considered statistically significant.

Abbreviations: C-NLR, CRP/neutrophil-to-lymphocyte ratio; C-LMR, CRP×lymphocyte-to-monocyte ratio.