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

Authors

• 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.Follow
• 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.Follow
• 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.Follow
• 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

DOI

10.1177/15910199221093896

Journal Title

Interventional Neuroradiology

First Page

386

Last Page

392

Document Type

Article

Publication Date

8-1-2023

Department

Neurosurgery

Second Department

Neurology

Keywords

COVID, Neutrophil lymphocyte ratio, acute ischemic stroke, large vessel occlusion

Disciplines

Medicine and Health Sciences

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.

Recommended Citation

Al-Mufti, F., Khandelwal, P., Sursal, T., Cooper, J. B., Feldstein, E., Amuluru, K., Moré, J. M., Tiwari, A., Singla, A., Dmytriw, A. A., Piano, M., Quilici, L., Pero, G., Renieri, L., Limbucci, N., Martínez-Galdámez, M., Schüller-Arteaga, M., Galván, J., Arenillas-Lara, J. F., Hashim, Z., Nayak, S., Desousa, K., Sun, H., Agarwalla, P. K., Sudipta Roychowdhury, J., Nourollahzadeh, E., Prakash, T., Xavier, A. R., Diego Lozano, J., Gupta, G., Yavagal, D. R., & Elghanem, M. (2023). Neutrophil-Lymphocyte Ratio Is Associated With Poor Clinical Outcome After Mechanical Thrombectomy in Stroke in Patients With COVID-19. Interventional Neuroradiology, 29 (4), 386-392. https://doi.org/10.1177/15910199221093896