title: Admission neutrophil-lymphocyte ratio predicts 90 day outcome after endovascular stroke therapy.
abstract: OBJECTIVE
  Immune dysregulation influences outcome following acute ischemic stroke (AIS). Admission white blood cell (WBC) counts are routinely obtained, making the neutrophil-lymphocyte ratio (NLR) a readily available biomarker of the immune response to stroke. This study sought to identify the relationship between NLR and 90 day AIS outcome.
  
  
  METHODS
  A retrospective analysis was performed on patients who underwent endovascular therapy for AIS at West Virginia University Hospitals, Morgantown, West Virginia. Admission WBC differentials were analyzed as the NLR. Stroke severity was measured by the National Institutes of Health Stroke Scale (NIHSS) score and outcome by the modified Rankin Scale (mRS) score at 90 days. Univariate relationships between NLR, age, NIHSS, and mRS were established by correlation coefficients; the t test was used to compare NLR with recanalization and stroke location (anterior vs posterior). Logistic regression models were developed to identify the ability of NLR to predict mRS when controlling for age, recanalization, and treatment with IV tissue plasminogen activator (tPA).
  
  
  RESULTS
  116 patients were reviewed from 2008 to 2011. Mean age of the sample was 67 years, and 54% were women. Mean baseline NIHSS score was 17 and 90 day mRS score was 4. There was a significant relationship between NLR and mRS (p=0.02) that remained when controlling for age, treatment with IV tPA, and recanalization. NLR ≥5.9 predicted poor outcome and death at 90 days.
  
  
  CONCLUSIONS
  This study shows that the NLR, a readily available biomarker, may be a clinically useful tool for risk stratification when evaluating AIS patients as candidates for endovascular therapies.
authors.affiliation: West Virginia University (WVU) School of Medicine, Morgantown, West Virginia, USA WVU Center for Neuroscience, Morgantown, West Virginia, USA.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Brooks
authors.affiliation: West Virginia University (WVU) School of Medicine, Morgantown, West Virginia, USA WVU School of Nursing, Morgantown, West Virginia, USA.
authors.forename: Chauncey
authors.initials: C
authors.lastname: Spears
authors.affiliation: West Virginia University (WVU) School of Medicine, Morgantown, West Virginia, USA West Virginia University Hospitals Department of Neurology, West Virginia University Hospitals, Morgantown, West Virginia, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Cummings
authors.affiliation: West Virginia University (WVU) School of Medicine, Morgantown, West Virginia, USA WVU School of Nursing, Morgantown, West Virginia, USA West Virginia University Department of Emergency Medicine, Morgantown, West Virginia, USA.
authors.forename: Reyna L
authors.initials: RL
authors.lastname: VanGilder
authors.affiliation: West Virginia University (WVU) School of Medicine, Morgantown, West Virginia, USA.
authors.forename: Kyle R
authors.initials: KR
authors.lastname: Stinehart
authors.affiliation: West Virginia University (WVU) School of Medicine, Morgantown, West Virginia, USA West Virginia University Hospitals Department of Neurology, West Virginia University Hospitals, Morgantown, West Virginia, USA.
authors.forename: Laurie
authors.initials: L
authors.lastname: Gutmann
authors.affiliation: West Virginia University Hospitals Department of Radiology/Interventional Neuroradiology, West Virginia University Hospital, Morgantown, West Virginia, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Domico
authors.affiliation: WVU School of Nursing, Morgantown, West Virginia, USA.
authors.forename: Stacey
authors.initials: S
authors.lastname: Culp
authors.affiliation: West Virginia University (WVU) School of Medicine, Morgantown, West Virginia, USA West Virginia University Hospitals Department of Radiology/Interventional Neuroradiology, West Virginia University Hospital, Morgantown, West Virginia, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Carpenter
authors.affiliation: West Virginia University (WVU) School of Medicine, Morgantown, West Virginia, USA West Virginia University Hospitals Department of Radiology/Interventional Neuroradiology, West Virginia University Hospital, Morgantown, West Virginia, USA.
authors.forename: Ansaar
authors.initials: A
authors.lastname: Rai
authors.affiliation: West Virginia University (WVU) School of Medicine, Morgantown, West Virginia, USA WVU Center for Neuroscience, Morgantown, West Virginia, USA WVU School of Nursing, Morgantown, West Virginia, USA West Virginia University Prevention Research Center, Morgantown, West Virginia, USA West Virginia University Department of Emergency Medicine, Morgantown, West Virginia, USA.
authors.forename: Taura L
authors.initials: TL
authors.lastname: Barr
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000494:pharmacology*; D006801:Humans; D007958:Leukocyte Count; D018655:Lymphocyte Count; D008214:Lymphocytes; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D011379:Prognosis; D012720:Severity of Illness Index; D020521:Stroke / Q000097:blood* / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000494:pharmacology*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Inflammatory Response; Stroke