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Neutrophil–Lymphocyte ratio is associated with poor clinical outcome after mechanical thrombectomy in stroke in patients with COVID-19

BACKGROUND: The neutrophil–lymphocyte ratio (NLR) is emerging as an important biomarker of acute physiologic stress in a myriad of medical conditions, and is a confirmed poor prognostic indicator in COVID-19. OBJECTIVE: We sought to describe the role of NLR in predicting poor outcome in COVID-19 pat...

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Autores principales: Al-Mufti, Fawaz, Khandelwal, Priyank, Sursal, Tolga, Cooper, Jared B., Feldstein, Eric, Amuluru, Krishna, Moré, Jayaji M., Tiwari, Ambooj, Singla, Amit, Dmytriw, Adam A, Piano, Mariangela, Quilici, Luca, Pero, Guglielmo, Renieri, Leonardo, Limbucci, Nicola, Martínez-Galdámez, Mario, Schüller-Arteaga, Miguel, Galván, Jorge, Arenillas-Lara, Juan Francisco, Hashim, Zafar, Nayak, Sanjeev, Desousa, Keith, Sun, Hai, Agarwalla, Pankaj K., Sudipta Roychowdhury, J, Nourollahzadeh, Emad, Prakash, Tannavi, Xavier, Andrew R, Diego Lozano, J, Gupta, Gaurav, Yavagal, Dileep R, Elghanem, Mohammad, Gandhi, Chirag D., Mayer, Stephan A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9006085/
https://www.ncbi.nlm.nih.gov/pubmed/35404161
http://dx.doi.org/10.1177/15910199221093896
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author Al-Mufti, Fawaz
Khandelwal, Priyank
Sursal, Tolga
Cooper, Jared B.
Feldstein, Eric
Amuluru, Krishna
Moré, Jayaji M.
Tiwari, Ambooj
Singla, Amit
Dmytriw, Adam A
Piano, Mariangela
Quilici, Luca
Pero, Guglielmo
Renieri, Leonardo
Limbucci, Nicola
Martínez-Galdámez, Mario
Schüller-Arteaga, Miguel
Galván, Jorge
Arenillas-Lara, Juan Francisco
Hashim, Zafar
Nayak, Sanjeev
Desousa, Keith
Sun, Hai
Agarwalla, Pankaj K.
Sudipta Roychowdhury, J
Nourollahzadeh, Emad
Prakash, Tannavi
Xavier, Andrew R
Diego Lozano, J
Gupta, Gaurav
Yavagal, Dileep R
Elghanem, Mohammad
Gandhi, Chirag D.
Mayer, Stephan A.
author_facet Al-Mufti, Fawaz
Khandelwal, Priyank
Sursal, Tolga
Cooper, Jared B.
Feldstein, Eric
Amuluru, Krishna
Moré, Jayaji M.
Tiwari, Ambooj
Singla, Amit
Dmytriw, Adam A
Piano, Mariangela
Quilici, Luca
Pero, Guglielmo
Renieri, Leonardo
Limbucci, Nicola
Martínez-Galdámez, Mario
Schüller-Arteaga, Miguel
Galván, Jorge
Arenillas-Lara, Juan Francisco
Hashim, Zafar
Nayak, Sanjeev
Desousa, Keith
Sun, Hai
Agarwalla, Pankaj K.
Sudipta Roychowdhury, J
Nourollahzadeh, Emad
Prakash, Tannavi
Xavier, Andrew R
Diego Lozano, J
Gupta, Gaurav
Yavagal, Dileep R
Elghanem, Mohammad
Gandhi, Chirag D.
Mayer, Stephan A.
author_sort Al-Mufti, Fawaz
collection PubMed
description BACKGROUND: The neutrophil–lymphocyte ratio (NLR) is emerging as an important biomarker of acute physiologic stress in a myriad of medical conditions, and is a confirmed poor prognostic indicator in COVID-19. OBJECTIVE: We sought to describe the role of NLR in predicting poor outcome in COVID-19 patients undergoing mechanical thrombectomy for acute ischemic stroke. METHODS: We analyzed NLR in COVID-19 patients with large vessel occlusion (LVO) strokes enrolled into an international 12-center retrospective study of laboratory-confirmed COVID-19, consecutively admitted between March 1, 2020 and May 1, 2020. Increased NLR was defined as ≥7.2. Logistic regression models were generated. RESULTS: Incidence of LVO stroke was 38/6698 (.57%). Mean age of patients was 62 years (range 27–87), and mortality rate was 30%. Age, sex, and ethnicity were not predictive of mortality. Elevated NLR and poor vessel recanalization (Thrombolysis in Cerebral Infarction (TICI) score of 1 or 2a) synergistically predicted poor outcome (likelihood ratio 11.65, p  =  .003). Patients with NLR > 7.2 were 6.8 times more likely to die (OR 6.8, CI95% 1.2–38.6, p  =  .03) and almost 8 times more likely to require prolonged invasive mechanical ventilation (OR 7.8, CI95% 1.2–52.4, p  =  .03). In a multivariate analysis, NLR > 7.2 predicted poor outcome even when controlling for the effect of low TICI score on poor outcome (NLR p  =  .043, TICI p  =  .070). CONCLUSIONS: We show elevated NLR in LVO patients with COVID-19 portends significantly worse outcomes and increased mortality regardless of recanalization status. Severe neuro-inflammatory stress response related to COVID-19 may negate the potential benefits of successful thrombectomy.
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spelling pubmed-90060852022-04-14 Neutrophil–Lymphocyte ratio is associated with poor clinical outcome after mechanical thrombectomy in stroke in patients with COVID-19 Al-Mufti, Fawaz Khandelwal, Priyank Sursal, Tolga Cooper, Jared B. Feldstein, Eric Amuluru, Krishna Moré, Jayaji M. Tiwari, Ambooj Singla, Amit Dmytriw, Adam A Piano, Mariangela Quilici, Luca Pero, Guglielmo Renieri, Leonardo Limbucci, Nicola Martínez-Galdámez, Mario Schüller-Arteaga, Miguel Galván, Jorge Arenillas-Lara, Juan Francisco Hashim, Zafar Nayak, Sanjeev Desousa, Keith Sun, Hai Agarwalla, Pankaj K. Sudipta Roychowdhury, J Nourollahzadeh, Emad Prakash, Tannavi Xavier, Andrew R Diego Lozano, J Gupta, Gaurav Yavagal, Dileep R Elghanem, Mohammad Gandhi, Chirag D. Mayer, Stephan A. Interv Neuroradiol Original Research Articles BACKGROUND: The neutrophil–lymphocyte ratio (NLR) is emerging as an important biomarker of acute physiologic stress in a myriad of medical conditions, and is a confirmed poor prognostic indicator in COVID-19. OBJECTIVE: We sought to describe the role of NLR in predicting poor outcome in COVID-19 patients undergoing mechanical thrombectomy for acute ischemic stroke. METHODS: We analyzed NLR in COVID-19 patients with large vessel occlusion (LVO) strokes enrolled into an international 12-center retrospective study of laboratory-confirmed COVID-19, consecutively admitted between March 1, 2020 and May 1, 2020. Increased NLR was defined as ≥7.2. Logistic regression models were generated. RESULTS: Incidence of LVO stroke was 38/6698 (.57%). Mean age of patients was 62 years (range 27–87), and mortality rate was 30%. Age, sex, and ethnicity were not predictive of mortality. Elevated NLR and poor vessel recanalization (Thrombolysis in Cerebral Infarction (TICI) score of 1 or 2a) synergistically predicted poor outcome (likelihood ratio 11.65, p  =  .003). Patients with NLR > 7.2 were 6.8 times more likely to die (OR 6.8, CI95% 1.2–38.6, p  =  .03) and almost 8 times more likely to require prolonged invasive mechanical ventilation (OR 7.8, CI95% 1.2–52.4, p  =  .03). In a multivariate analysis, NLR > 7.2 predicted poor outcome even when controlling for the effect of low TICI score on poor outcome (NLR p  =  .043, TICI p  =  .070). CONCLUSIONS: We show elevated NLR in LVO patients with COVID-19 portends significantly worse outcomes and increased mortality regardless of recanalization status. Severe neuro-inflammatory stress response related to COVID-19 may negate the potential benefits of successful thrombectomy. SAGE Publications 2022-04-11 2023-08 /pmc/articles/PMC9006085/ /pubmed/35404161 http://dx.doi.org/10.1177/15910199221093896 Text en © The Author(s) 2022
spellingShingle Original Research Articles
Al-Mufti, Fawaz
Khandelwal, Priyank
Sursal, Tolga
Cooper, Jared B.
Feldstein, Eric
Amuluru, Krishna
Moré, Jayaji M.
Tiwari, Ambooj
Singla, Amit
Dmytriw, Adam A
Piano, Mariangela
Quilici, Luca
Pero, Guglielmo
Renieri, Leonardo
Limbucci, Nicola
Martínez-Galdámez, Mario
Schüller-Arteaga, Miguel
Galván, Jorge
Arenillas-Lara, Juan Francisco
Hashim, Zafar
Nayak, Sanjeev
Desousa, Keith
Sun, Hai
Agarwalla, Pankaj K.
Sudipta Roychowdhury, J
Nourollahzadeh, Emad
Prakash, Tannavi
Xavier, Andrew R
Diego Lozano, J
Gupta, Gaurav
Yavagal, Dileep R
Elghanem, Mohammad
Gandhi, Chirag D.
Mayer, Stephan A.
Neutrophil–Lymphocyte ratio is associated with poor clinical outcome after mechanical thrombectomy in stroke in patients with COVID-19
title Neutrophil–Lymphocyte ratio is associated with poor clinical outcome after mechanical thrombectomy in stroke in patients with COVID-19
title_full Neutrophil–Lymphocyte ratio is associated with poor clinical outcome after mechanical thrombectomy in stroke in patients with COVID-19
title_fullStr Neutrophil–Lymphocyte ratio is associated with poor clinical outcome after mechanical thrombectomy in stroke in patients with COVID-19
title_full_unstemmed Neutrophil–Lymphocyte ratio is associated with poor clinical outcome after mechanical thrombectomy in stroke in patients with COVID-19
title_short Neutrophil–Lymphocyte ratio is associated with poor clinical outcome after mechanical thrombectomy in stroke in patients with COVID-19
title_sort neutrophil–lymphocyte ratio is associated with poor clinical outcome after mechanical thrombectomy in stroke in patients with covid-19
topic Original Research Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9006085/
https://www.ncbi.nlm.nih.gov/pubmed/35404161
http://dx.doi.org/10.1177/15910199221093896
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