J Cerebrovasc Endovasc Neurosurg.  2022 Sep;24(3):221-231. 10.7461/jcen.2022.E2021.10.003.

Prognostic significance of platelet-to-lymphocyte and platelet-to-neutrophil ratios in patients with mechanical thrombectomy for acute ischemic stroke

• Kim Sy
• Yi HJ
• Shin DS
• Kim BT

• KMID: 2533673
• DOI: http://doi.org/10.7461/jcen.2022.E2021.10.003

Abstract

Objective
The present study aimed to analyze the correlation between platelet-to-lymphocyte ratio (PLR) and platelet-to-neutrophil ratio (PNR) with prognosis of patients who underwent mechanical thrombectomy (MT).
Methods
A total of 432 patients was included, PLR and PNR were calculated from laboratory data on admission. Prognosis was evaluated with a modified Rankin Scale at 3 months after MT. Using receiver operating characteristic (ROC) analysis, optimal cutoff values of PLR and PNR were identified to predict the prognosis after MT. Multivariate analyses were performed to identify the relationship of PLR and PLR with prognosis of MT.
Results
Patients with favorable outcomes had a lower mean PLR (135.0, standard deviation [SD] 120.3) with a higher mean PNR (47.1 [SD] 24.6) compared with patients with unfavorable outcomes (167.6 [SD] 139.3 and 35.4 [SD] 22.4) (p<0.001 and <0.001, respectively). In ROC analyses, the optimal cutoff value of PLR and PNR to predict the 3 months prognosis were 145 and 41, respectively (p=<0.001 and p=0.006). In multivariate analysis, PLR less than 145 (odds ratio [OR] 1.29, 95% confidence interval [CI] 1.06–2.06; p=0.016) and PNR greater than 41 (OR 1.22, 95% CI 1.10–1.62; p=0.022) were predictors of favorable outcome at 3 months.
Conclusions
In patients with MT, PLR and PNR on admission could be predictive factors of prognosis and mortality at 3 months. Decreased PLR and increased PNR were associated with favorable clinical outcome 3 months after MT.

Keyword

Leukocytes; Lymphocytes; Neutrophils; Platelets; Thrombectomy

Figure

• 

  Fig. 1. Box plots of platelet-to-lymphocyte ratio (PLR), platelet-to-neutrophil ratio (PNR), and platelet-to-white blood cell ratio (PWR) between the groups. (A) The patients with favorable modified Rankin Scale (mRS) score (0-2) had lower mean PLR value than patients with unfavorable mRS (p<0.001). (B) Comparison of PNR between groups showed significantly higher PNR in patients with favorable mRS (p<0.001). (C) The mean value of PWR was higher in favorable mRS patients, compared with unfavorable mRS patients (p=0.009).

• 

  Fig. 2. Receiver operating characteristic (ROC) curve of platelet-to-lymphocyte ratio (PLR), platelet-to-neutrophil ratio (PNR), and platelet-to-white blood cell ratio (PWR) on prognosis of patients who underwent MT for LAO. The optimal cutoff value of PLR level to discriminate between favorable (0-2) and unfavorable (3-6) modified Rankin Scale (mRS) scores at 3 months was 145 (area under the curve (AUC) 0.663, 95% CI 0.611–0.715; p<0.001). In addition, a PNR value of 41 (AUC 0.616, 95% CI 0.572-0.660; p=0.001) and PWR value of 25 (AUC 0.583, 95% CI 0.521-0.645; p=0.006) were identified as the optimal cutoff values to predict favorable 3 months mRS after MT, respectively. MT, mechanical thrombectomy; CI, confidence interval

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