Neutrophil-Lymphocyte Ratio Associated With Poor Clinical Outcome After Mechanical Thrombectomy Following Large Vessel Occlusion Stroke in Patients With COVID-19

Author Type(s)

Faculty

Document Type

Abstract

Publication Date

4-13-2021

Journal Title

Neurology

Department

Neurosurgery

Second Department

Neurology

Abstract

Objective:

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Background:

The neutrophil–lymphocyte ratio (NLR) is emerging as a biomarker in patients with a myriad of medical conditions. NLR has been confirmed as a potential short-term prognostic indicator for patients with COVID-19. Neutrophil-to-lymphocyte ratio predicts critical illness patients with 2019 coronavirus disease in the early stage and has been established as a predictor of disease progression and critical deterioration in COVID 19 [Jingyuan Liu]. We sought to describe the role of NLR in predicting poor outcome in patients COVID-19 patients undergoing mechanical thrombectomy subset of consecutive COVID-19 patients with acute ischemic stroke.

Design/Methods:

We evaluated COVID-19 patients with LVO Strokes enrolled into an international 12 center retrospective study of laboratory-confirmed COVID-19 consecutively admitted between March 1st and May 1st in 12. Admission WBC differentials (NLR) were analyzed using a cutoff of ≥ 7.2. Logistic regression models were generated.

Results:

Out of a total of 6698 patients admitted with COVID-19 positive in 12 stroke centers during the study period, the incidence of large vessel occlusion stroke was 38/6698 (0.8%). An elevated NLR and low TICI grade (TICI1 or TICI2a) are synergistically predictive of worse outcome (LR 11.65 p=0.0030). Patients with an NLR >7.2 were 6.8 times more likely to die (OR 6.8, CI95% 1.2–38.6, p=0.03) and almost 6 times more likely to have a poor outcome (OR 5.9, CI95% 1.3–27.3, p=0.02). Patients with an NLR > 7.2 were almost 8 times more likely to require prolonged invasive mechanical ventilation (OR 7.8, CI95% 1.2–52.4, p=0.03).

Conclusions:

An elevated NLR in the setting of COVID 19 patients with LVO strokes portends significantly worse outcomes and increased mortality regardless of TICI score indicating that the neuroinflammatory response in COVID-19 outweighs any potential benefit of a successful thrombectomy. Disclosure: Dr. Al-Mufti has nothing to disclose. Tolga Sursal has nothing to disclose. Dr. Alshammari has nothing to disclose. Dr. Gandhi has nothing to disclose. Dr. Mayer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Braincool. Dr. Mayer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bayer. Dr. Mayer has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for MaxQ AI. Dr. Mayer has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Mayer has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Idorsia. Dr. Mayer has received stock or an ownership interest from Neuroptics. Dr. Mayer has received publishing royalties from a publication relating to health care.

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