Chaiwisitkun A, Muengtaweepongsa S. Platelet-to-neutrophil ratio predicts hemorrhagic transformation and unfavorable outcomes in acute ischemic stroke with intravenous thrombolysis. World J Exp Med 2024; 14(3): 95540 [DOI: 10.5493/wjem.v14.i3.95540]
Corresponding Author of This Article
Sombat Muengtaweepongsa, MD, MSc, Professor, Center of Excellence in Stroke, Division of Neurology, Department of Medicine, Faculty of Medicine, Thammasat University, Rangsit Campus, No. 99/209 Paholyothin Road, Klonglaung 12120, Pathum Thani, Thailand. musombat@tu.ac.th
Research Domain of This Article
Medicine, General & Internal
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Exp Med. Sep 20, 2024; 14(3): 95540 Published online Sep 20, 2024. doi: 10.5493/wjem.v14.i3.95540
Platelet-to-neutrophil ratio predicts hemorrhagic transformation and unfavorable outcomes in acute ischemic stroke with intravenous thrombolysis
Ausanee Chaiwisitkun, Sombat Muengtaweepongsa
Ausanee Chaiwisitkun, Sombat Muengtaweepongsa, Center of Excellence in Stroke, Faculty of Medicine, Thammasat University, Klonglaung 12120, Pathum Thani, Thailand
Author contributions: Chaiwisitkun A and Muengtaweepongsa S were responsible for the conceptualization and design of the study; Muengtaweepongsa S was responsible for the formal analysis; Chaiwisitkun A and Muengtaweepongsa S were responsible for the investigation; Chaiwisitkun A was responsible for the original draft preparation; Muengtaweepongsa S was responsible for validation, review, and editing.
Institutional review board statement: The Human Research Ethics Committee of Thammasat University (Medicine) bestowed approval for this study and granted a waiver for the requirement of informed consent, under approval number 284/2564. All methodologies employed throughout the study adhered scrupulously to pertinent guidelines and regulations.
Informed consent statement: The Human Research Ethics Committee of Thammasat University (Medicine) bestowed approval for this study and granted a waiver for the requirement of informed consent, under approval number 284/2564.
Conflict-of-interest statement: The author(s) declare no competing interests.
Data sharing statement: The datasets generated and/or analyzed during the current study are available in the Research Gate repository, DOI: 10.13140/RG.2.2.25908.73606.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sombat Muengtaweepongsa, MD, MSc, Professor, Center of Excellence in Stroke, Division of Neurology, Department of Medicine, Faculty of Medicine, Thammasat University, Rangsit Campus, No. 99/209 Paholyothin Road, Klonglaung 12120, Pathum Thani, Thailand. musombat@tu.ac.th
Received: April 12, 2024 Revised: May 22, 2024 Accepted: June 12, 2024 Published online: September 20, 2024 Processing time: 138 Days and 21.7 Hours
Abstract
BACKGROUND
Acute ischemic stroke (AIS) retains a notable stance in global disease burden, with thrombolysis via recombinant tissue plasminogen activator (rtPA) serving as a viable management approach, albeit with variable outcomes and the potential for complications like hemorrhagic transformation (HT). The platelet-to-neutrophil ratio (P/NR) has been considered for its potential prognostic value in AIS, yet its capacity to predict outcomes following rtPA administration demands further exploration.
AIM
To elucidate the prognostic utility of P/NR in predicting HT and clinical outcomes following intravenous rtPA administration in AIS patients.
METHODS
Data from 418 AIS patients treated with intravenous rtPA at Thammasat University Hospital from January 2018 to June 2021 were retrospectively analyzed. The relationship between P/NR and clinical outcomes [early neurological deterioration (E-ND), HT, delayed ND (D-ND), and 3-mo outcomes] was scrutinized.
RESULTS
Notable variables, such as age, diabetes, and stroke history, exhibited statistical disparities when comparing patients with and without E-ND, HT, D-ND, and 3-mo outcomes. P/NR prognostication revealed an optimal cutoff of 43.4 with a 60.3% sensitivity and a 52.5% specificity for 90-d outcomes. P/NR prognostic accuracy was statistically significant for 90-d outcomes [area under the curve (AUC) = 0.562], D-ND (AUC = 0.584), and HT (AUC = 0.607).
CONCLUSION
P/NR demonstrated an association with adverse 3-mo clinical outcomes, HT, and D-ND in AIS patients post-rtPA administration, indicating its potential as a predictive tool for complications and prognoses. This infers that a diminished P/NR may serve as a novel prognostic indicator, assisting clinicians in identifying AIS patients at elevated risk for unfavorable outcomes following rtPA therapy.
Core Tip: The study explored the prognostic value of the platelet-to-neutrophil ratio (P/NR) in patients with acute ischemic stroke (AIS) who underwent thrombolysis with recombinant tissue plasminogen activator (rtPA). It aimed to determine if P/NR could predict hemorrhagic transformation and clinical outcomes following rtPA treatment. An optimal P/NR cutoff value was identified for predicting 90-d outcomes with moderate sensitivity and specificity. The study concluded that P/NR is associated with negative 3-mo outcomes, suggesting it could be a useful indicator for predicting risks post-rtPA treatment in AIS patients.
