NYMC Faculty Publications

Neutrophil-Lymphocyte Ratio Is Associated With Poor Clinical Outcome After Mechanical Thrombectomy in Stroke in Patients With COVID-19

Fawaz Al-Mufti, Department of Neurosurgery, New York Medical College, Westchester Medical Center, Valhalla, New York, USA.Follow
Priyank Khandelwal, Department of Neurological Surgery, University Hospital Newark, New Jersey Medical School, Rutgers, New Jersey, USA.
Tolga Sursal, Department of Neurosurgery, New York Medical College, Westchester Medical Center, Valhalla, New York, USA.
Jared B. Cooper, Department of Neurosurgery, New York Medical College, Westchester Medical Center, Valhalla, New York, USA.
Eric Feldstein, Department of Neurosurgery, New York Medical College, Westchester Medical Center, Valhalla, New York, USA.
Krishna Amuluru, Department of Neurointerventional Radiology, Goodman Campbell Brain and Spine, Indianapolis, Indiana, USA.
Jayaji M. Moré, Department of Neurosurgery, New York Medical College, Westchester Medical Center, Valhalla, New York, USA.
Ambooj Tiwari, Department of Neurology, Brookdale and Jamaica Hospital Center, NYU School of Medicine, Brooklyn, New York, USA.
Amit Singla, Department of Neurological Surgery, University Hospital Newark, New Jersey Medical School, Rutgers, New Jersey, USA.
Adam A. Dmytriw, Neuroradiology and Neurointervention Service, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Mariangela Piano, Department of Neuroradiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
Luca Quilici, Department of Neuroradiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
Guglielmo Pero, Department of Neuroradiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
Leonardo Renieri, Department of Radiology, Neurovascular Unit, Careggi University Hospital, Florence, Italy.
Nicola Limbucci, Department of Radiology, Neurovascular Unit, Careggi University Hospital, Florence, Italy.
Mario Martínez-Galdámez, Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
Miguel Schüller-Arteaga, Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
Jorge Galván, Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
Juan Francisco Arenillas-Lara, Department of Interventional Neuroradiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
Zafar Hashim, Department of Radiology, University Hospital of North Midlands, Stoke-on-Trent, UK.
Sanjeev Nayak, Department of Radiology, University Hospital of North Midlands, Stoke-on-Trent, UK.
Keith Desousa, Department of Neurology, Northwell Health, Long Island, New York, New York, USA.
Hai Sun, Department of Neurological Surgery, Rutgers Robert Wood Johnson Medical School, New Jersey Medical School, New Brunswick, New Jersey, USA.
Pankaj K. Agarwalla, Department of Neurological Surgery, University Hospital Newark, New Jersey Medical School, Rutgers, New Jersey, USA.
J Sudipta Roychowdhury, Department of Neurology & Radiology, Robert Wood Johnson University Hospital, Rutgers, New Jersey, USA.
Emad Nourollahzadeh, Department of Neurology & Radiology, Robert Wood Johnson University Hospital, Rutgers, New Jersey, USA.
Tannavi Prakash, Department of Neurological Surgery, University Hospital Newark, New Jersey Medical School, Rutgers, New Jersey, USA.
Andrew R. Xavier, Department of Neurology, Saint Joseph Health, Detroit Medical Center, Detroit, Michigan, USA.
J Diego Lozano, Department of Radiology, University of California Riverside, Riverside, California, USA.
Gaurav Gupta, Department of Neurological Surgery, Rutgers Robert Wood Johnson Medical School, New Jersey Medical School, New Brunswick, New Jersey, USA.
Dileep R. Yavagal, Department of Neurology, Miller School of Medicine, Miami, Florida, USA.
Mohammad Elghanem, Department of Neurology, University of Arizona-Tucson, Tucson, Arizona, USA.

Author Type(s)

Faculty, Resident/Fellow

Journal Title

Interventional Neuroradiology

First Page

386

Last Page

392

Document Type

Article

Publication Date

8-1-2023

Department

Neurosurgery

Second Department

Neurology

Abstract

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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