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Dynamic increase in neutrophil levels predicts parenchymal hemorrhage and function outcome of ischemic stroke with r-tPA thrombolysis

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Abstract

Background

The higher level of neutrophil on admission has been reported to predict worse 3-month outcomes in ischemic stroke patients. Our study was to explore the dynamic changes of neutrophil and lymphocyte after r-tPA thrombolysis of ischemic stroke and the relationship with parenchymal hemorrhage (PH) and 3-month function outcome.

Methods

A total of 208 acute ischemic stroke (AIS) patients with intravenous thrombolysis were included and then received 3-month follow-up in the present study. Blood samples for neutrophil and lymphocyte counts were obtained on admission, at 24 h and at 7 days after r-tPA infusion. The associations of increase in neutrophil, lymphocyte, and neutrophil to lymphocyte ratio (NLR) with PH or 3-month poor outcome were examined by logistic regression.

Results

Increasing trends in the neutrophil and NLR were observed in AIS patients after r-tPA treatment. Increased level of neutrophil at 24 h after r-tPA infusion but not that on admission was associated with PH (OR = 2.86, P = 0.029) and 3-month poorer functional outcomes (OR = 2.67, P = 0.009). Moreover, patients were divided into four groups according to the percent change in neutrophil within 24 h following r-tPA treatment, and we found that there was a trend of incremental OR when compared higher increase group with lower ones.

Conclusions

Dynamic increase in neutrophil and NLR after stroke may predict PH and 3-month poor outcome in AIS patients receiving r-tPA treatment. Therefore, neutrophil and NLR may serve as activity markers for PH and 3-month poor prognosis in AIS patients with intravenous thrombolysis.

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Abbreviations

PH:

Parenchymal hemorrhage

HT:

Hemorrhagic transformation

AIS:

Acute ischemic stroke

NLR:

Neutrophil to lymphocyte ratio

r-tPA:

Recombinant tissue plasminogen activator

MMP-9:

Matrix metalloproteinase-9

BBB:

Blood-brain barrier

OTT:

Onset to treatment time

SBP:

Systolic blood pressure

DBP:

Diastolic blood pressure

NIHSS:

National Institutes of Health Stroke Scale

MRS:

Modified Rankin scale

SD:

Standard deviation

MCAO:

Middle cerebral artery occlusion

CRP:

C-Reactive protein

OR:

Odds ratio

CI:

Confidence interval

IQR:

Interquartile ranges

sICH:

Symptomatic intracerebral hemorrhages

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Funding

This study was supported by the National Natural Science Foundation of China (81673144).

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Author notes

  1. AnNa Ying and YaNi Cheng contributed equally to this work.

Authors and Affiliations

  1. Department of Neurology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China

    AnNa Ying, YaNi Cheng, YanYan Lin & YuanShao Lin

  2. Department of Neurology, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China

    JunRu Yu

  3. Department of Rehabilitation, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China

    XiaoYun Wu

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  1. AnNa Ying
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Correspondence to YuanShao Lin.

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Ying, A., Cheng, Y., Lin, Y. et al. Dynamic increase in neutrophil levels predicts parenchymal hemorrhage and function outcome of ischemic stroke with r-tPA thrombolysis. Neurol Sci 41, 2215–2223 (2020). https://doi.org/10.1007/s10072-020-04324-6

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  • DOI: https://doi.org/10.1007/s10072-020-04324-6

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