Values of lymphocyte-related ratios in predicting the clinical outcome of acute ischemic stroke patients receiving intravenous thrombolysis based on different etiologies
BackgroundWhile neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) have been associated with acute ischemic stroke (AIS) outcomes, their differential predictive value across etiological subtypes (TOAST classification) in thrombolysis-trea...
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Frontiers Media S.A.
2025-05-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2025.1542889/full |
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| author | Yongyu Li Keyang Chen Lu Wang Linhu Zhao Chunyan Lei Yu Gu Xiaoyan Zhu Qionghua Deng |
| author_facet | Yongyu Li Keyang Chen Lu Wang Linhu Zhao Chunyan Lei Yu Gu Xiaoyan Zhu Qionghua Deng |
| author_sort | Yongyu Li |
| collection | DOAJ |
| description | BackgroundWhile neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) have been associated with acute ischemic stroke (AIS) outcomes, their differential predictive value across etiological subtypes (TOAST classification) in thrombolysis-treated patients remains underexplored.MethodsIn this retrospective cohort study, we analyzed 381 AIS patients receiving intravenous thrombolysis. Hematological indices were calculated from pre-thrombolysis. Using multivariable logistic regression adjusted for age, NIHSS, and comorbidities, we assessed associations between baseline ratios and 90-day unfavorable outcomes (mRS 3–6). Receiver operating characteristic (ROC) analysis was used to determine optimal cutoffs stratified by TOAST subtypes.ResultsA total of 381 patients were included in the study. NLR showed superior predictive performance: large-artery atherosclerosis: AUC = 0.702 (aOR = 1.35, 95%CI = 1.14–1.61, p = 0.001), small-artery occlusion: AUC = 0.750 (aOR = 1.51, 95%CI = 1.08–2.10, p = 0.015), cardioembolic stroke: AUC = 0.679 (aOR = 1.82, 95%CI = 1.07–3.10, p = 0.028). LMR showed predictive value only in large-artery atherosclerosis (AUC = 0.632, p = 0.004). Optimal NLR cutoffs: 3.19 (large-artery), 3.94 (small-artery), 3.17 (cardioembolic stroke).ConclusionNLR emerged as a robust, subtype-specific predictor of post-thrombolysis outcomes, particularly in atherosclerotic stroke variants. These findings supported NLR’s clinical utility for risk stratification in thrombolysis-eligible AIS patients. |
| format | Article |
| id | doaj-art-a6d1d8b5d7094d9f970239b018500f40 |
| institution | Kabale University |
| issn | 1664-2295 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj-art-a6d1d8b5d7094d9f970239b018500f402025-08-20T03:48:51ZengFrontiers Media S.A.Frontiers in Neurology1664-22952025-05-011610.3389/fneur.2025.15428891542889Values of lymphocyte-related ratios in predicting the clinical outcome of acute ischemic stroke patients receiving intravenous thrombolysis based on different etiologiesYongyu LiKeyang ChenLu WangLinhu ZhaoChunyan LeiYu GuXiaoyan ZhuQionghua DengBackgroundWhile neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) have been associated with acute ischemic stroke (AIS) outcomes, their differential predictive value across etiological subtypes (TOAST classification) in thrombolysis-treated patients remains underexplored.MethodsIn this retrospective cohort study, we analyzed 381 AIS patients receiving intravenous thrombolysis. Hematological indices were calculated from pre-thrombolysis. Using multivariable logistic regression adjusted for age, NIHSS, and comorbidities, we assessed associations between baseline ratios and 90-day unfavorable outcomes (mRS 3–6). Receiver operating characteristic (ROC) analysis was used to determine optimal cutoffs stratified by TOAST subtypes.ResultsA total of 381 patients were included in the study. NLR showed superior predictive performance: large-artery atherosclerosis: AUC = 0.702 (aOR = 1.35, 95%CI = 1.14–1.61, p = 0.001), small-artery occlusion: AUC = 0.750 (aOR = 1.51, 95%CI = 1.08–2.10, p = 0.015), cardioembolic stroke: AUC = 0.679 (aOR = 1.82, 95%CI = 1.07–3.10, p = 0.028). LMR showed predictive value only in large-artery atherosclerosis (AUC = 0.632, p = 0.004). Optimal NLR cutoffs: 3.19 (large-artery), 3.94 (small-artery), 3.17 (cardioembolic stroke).ConclusionNLR emerged as a robust, subtype-specific predictor of post-thrombolysis outcomes, particularly in atherosclerotic stroke variants. These findings supported NLR’s clinical utility for risk stratification in thrombolysis-eligible AIS patients.https://www.frontiersin.org/articles/10.3389/fneur.2025.1542889/fullstrokeetiologythrombolysisneutrophillymphocyteoutcome |
| spellingShingle | Yongyu Li Keyang Chen Lu Wang Linhu Zhao Chunyan Lei Yu Gu Xiaoyan Zhu Qionghua Deng Values of lymphocyte-related ratios in predicting the clinical outcome of acute ischemic stroke patients receiving intravenous thrombolysis based on different etiologies Frontiers in Neurology stroke etiology thrombolysis neutrophil lymphocyte outcome |
| title | Values of lymphocyte-related ratios in predicting the clinical outcome of acute ischemic stroke patients receiving intravenous thrombolysis based on different etiologies |
| title_full | Values of lymphocyte-related ratios in predicting the clinical outcome of acute ischemic stroke patients receiving intravenous thrombolysis based on different etiologies |
| title_fullStr | Values of lymphocyte-related ratios in predicting the clinical outcome of acute ischemic stroke patients receiving intravenous thrombolysis based on different etiologies |
| title_full_unstemmed | Values of lymphocyte-related ratios in predicting the clinical outcome of acute ischemic stroke patients receiving intravenous thrombolysis based on different etiologies |
| title_short | Values of lymphocyte-related ratios in predicting the clinical outcome of acute ischemic stroke patients receiving intravenous thrombolysis based on different etiologies |
| title_sort | values of lymphocyte related ratios in predicting the clinical outcome of acute ischemic stroke patients receiving intravenous thrombolysis based on different etiologies |
| topic | stroke etiology thrombolysis neutrophil lymphocyte outcome |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2025.1542889/full |
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