Platelet-to-neutrophil ratio predicts hemorrhagic transformation and unfavorable outcomes in acute ischemic stroke with intravenous thrombolysis

doi:10.5493/wjem.v14.i3.95540

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World Journal of Experimental Medicine

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Retrospective Study

World J Exp Med. Sep 20, 2024; 14(3): 95540
Published online Sep 20, 2024. doi: 10.5493/wjem.v14.i3.95540

Table 1 Clinical characteristics of the study population

Characteristics	Number
Age in yr	64.5 (53-72)
Sex
Male	249 (59.6)
Female	169 (40.4)
Risk factor
Hypertension	299 (71.5)
Dyslipidemia	276 (66)
Diabetes mellitus	141 (33.7)
Atrial fibrillation/atrial flutter	102 (24.4)
Old stroke	47 (11.2)
Current smoking	73 (17.5)
Current alcohol drinking	42 (10)
Etiology
Other determined or undetermined	177 (42.3)
Cardioembolic	102 (24.4)
Small-artery occlusion	94 (22.5)
Large-artery atherosclerosis	42 (10)
Medication before stroke onset
Antihypertensive therapy	202 (48.3)
Antiplatelet therapy	81 (18.3)
Hypoglycemic therapy	121 (27.3)
Time for stroke onset to intravenous rtPA infusion in min	170.05 (124-218.25)
Infarct volume in mL	3.27 (0.58-24.24)
Hemorrhagic transformation
No	343 (82)
Yes	75 (82)
PH1	29 (82)
PH2	27 (6.1)
HI1	12 (2.7)
HI2	7 (1.6)

Data are n (%)/median (25^th-75^th percentiles). HI: Hemorrhagic infarct; PH: Parenchymal hemorrhage; rtPA: Recombinant tissue plasminogen activator.

Table 2 Clinical characteristics of the study population (continued)

Characteristics	Number
Baseline blood glucose in mg%	110 (96-141)
Laboratory tests
Hb	13.3 (12.2-14.4)
WBC as 10⁹/L	8.4 (6.81-10.51)
Platelets as 10⁹/L	227 (192-278)
Neutrophil as 10⁹/L	5.14 (3.8-7.06)
Lymphocyte as 10⁹/L	1.93 (1.36-2.7)
P/NR	43.73 (32.0-59.04)
PLR	115.33 (87.17-170.64)
NLR	2.56 (1.61-4.52)
PWR	27.07 (21.4-33.99)
LDL	114.5 (89-143)
NIHSS on admission	10 (6-16)
NIHSS score on discharge date (day 1-7)	5 (1-10)
Outcome events
Increase NIHSS from baseline or death within 7 d after IV rt-PA
Poor outcome (≥ 4 score)	24 (5.7)
Good outcome (< 4 score)	394 (94.3)
mRS on admission	5 (3.75-5)
Poor outcome (3-6)	348 (83.3)
Good outcome (0-2)	70 (16.7)
mRS on discharge date (day 1-7)	3 (1-4)
Poor outcome (3-6)	236 (56.5)
Good outcome (0-2)	182 (43.5)
mRS at 3 mo	2 (0-4)
Poor outcome (3-6)	168 (40.2)
Good outcome (0-2)	250 (59.8)

Data are n (%)/median (25^th-75^th percentiles). Hb: Hemoglobin; LDL: Low density lipoprotein; mRS: Modified Rankin Scale; NIHSS: National Institute of Health Stroke Scale; NLR: Neutrophil-to-lymphocyte ratio; P/NR: Platelet-to-neutrophil ratio; PLR: Platelet-to-lymphocyte ratio; WBC: White blood cell.

Table 3 Clinical characteristics of patients according to presence/absence of early neurological deterioration and hemorrhagic transformation after intravenous recombinant tissue plasminogen activator treatment

Variables	Total, n = 418	No E-ND, n = 394	E-ND, n = 24	P value	No HT, n = 342	HT, n = 75	P value
Age in yr	64.5 (53-72)	64 (52-71)	70 (58.75-77.25)	0.045¹	65 (53-72)	64 (52-74)	0.939¹
Sex
Male	249 (59.6)	237 (60.2)	12 (50)	0.325²	206 (60.2)	42 (56.0)	0.4992
Female	169 (40.4)	157 (39.8)	12 (50)		136 (39.8)	33 (44.0)
Risk factor
Hypertension	299 (71.5)	279 (71.2)	20 (83.3)	0.198²	245 (72.1)	53 (70.7)	0.808²
Dyslipidemia	276 (66.0)	261 (66.9)	15 (62.5)	0.655²	223 (65.8)	52 (70.3)	0.458²
Diabetes mellitus	141 (33.7)	126 (32.1)	15 (62.5)	0.002²	114 (33.4)	26 (34.7)	0.838²
Atrial fibrillation/ atrial flutter	102 (24.4)	97 (24.6)	5 (20.8)	0.675²	81 (23.7)	21 (28.0)	0.431²
Old stroke	47 (11.2)	44 (11.3)	3 (12.5)	0.852²	44 (13.0)	3 (4.0)	0.027²
Current smoking	73 (17.5)	70 (82.4)	3 (100)	0.424²	62 (83.8)	10 (76.9)	0.546²
Current alcohol drinking	42 (10.0)	42 (91.3)	0 (0)	0.003²	37 (90.2)	5 (83.3)	0.608²
Etiology
Other determined or undetermined	177 (42.3)	161 (41.2)	16 (66.7)	0.005²	143 (42.1)	34 (45.3)	< 0.001²
Cardioembolic	102 (24.4)	100 (25.6)	2 (8.3)		73 (21.5)	29 (38.7)
Small-artery occlusion	94 (22.5)	93 (23.8)	1 (4.2)		91 (26.8)	3 (4.0)
Large-artery atherosclerosis	42 (10)	37 (9.5)	5 (20.8)		33 (9.7)	9 (12.0)
Medication
Antihypertensive therapy	202 (45.6)	75 (19.0)	6 (25.0)	0.473²	165 (48.2)	37 (49.3)	0.864²
Antiplatelet therapy	81 (18.3)	191 (48.5)	11 (45.8)	0.801²	63 (18.4)	18 (24.0)	0.269²
Hypoglycemic therapy	121 (27.3)	111 (28.2)	10 (41.7)	0.16²	96 (28.2)	25 (33.3)	0.371²
Infarct volume in mL	3.27 (0.58-24.24)	2.76 (0.45-20.25)	34.42 (5.57-303.93)	< 0.001¹	2.67 (0.43-16.88)	13.99 (1.11-73.07)	0.389¹
Time for stroke onset to intravenous rtPA infusion in min	170.05 (124-218.25)	170 (122-217)	180.5 (147.5-232.25)	0.157¹	172 (124.85-218.25)	160 (124-219)	0.516¹

¹Mann Whitney U test.

²χ² test.

Data are n (%)/median (25^th-75^th percentiles). E-ND: Early neurological deterioration; HT: Hemorrhagic transformation; rtPA: Recombinant tissue plasminogen activator.

Table 4 Clinical characteristics of patients according to presence/absence of delayed neurological deterioration and 3-mo outcome after intravenous recombinant tissue plasminogen activator treatment

Variables	Total, n = 418	No D-ND, n = 182	D-ND, n = 236	P value	Good 3-months, n = 250	Poor 3-months, n = 168	P value
Age in yr	64.5 (53-72)	60 (49-67.25)	67 (58-76.75)	< 0.001¹	60 (50-68)	69 (61-75)	< 0.001¹
Sex
Male	249 (59.6)	120 (65.9)	129 (54.7)	0.02²	162 (64.8)	87 (51.8)	0.008²
Female	169 (40.4)	62 (34.1)	107 (45.3)		88 (35.2)	81 (48.2)
Risk factor
Hypertension	299 (71.5)	114 (62.6)	185 (79.1)	< 0.001²	163 (65.2)	136 (81.9)	< 0.001²
Dyslipidemia	276 (66.0)	113 (62.8)	163 (69.7)	0.141²	162 (65.3)	114 (68.7)	0.478²
Diabetes Mellitus	141 (33.7)	55 (30.4)	86 (36.4)	0.195²	73 (29.3)	68 (40.5)	0.018²
Atrial fibrillation/atrial flutter	102 (24.4)	40 (22.0)	62 (26.3)	0.311²	53 (21.2)	49 (29.2)	0.063²
Old stroke	47 (11.2)	16 (8.8)	31 (13.2)	0.16²	24 (9.7)	23 (13.7)	0.21²
Current smoking	73 (17.5)	38 (86.4)	35 (79.5)	0.395²	52 (85.2)	21 (77.8)	0.39²
Current alcohol drinking	42 (10.0)	20 (95.2)	22 (84.6)	0.24²	30 (88.2)	12 (92.3)	0.685²
Etiology
Other determined or undetermined	177 (42.3)	69 (38.3)	108 (46.0)	0.004²	93 (37.5)	84 (50.3)	0.002²
Cardioembolic	102 (24.4)	51 (28.3)	51 (21.7)		70 (28.2)	32 (19.2)
Small-artery occlusion	94 (22.5)	50 (27.8)	44 (18.7)		66 (26.6)	28 (16.8)
Large-artery atherosclerosis	42(10)	10 (5.6)	32 (13.6)		19 (7.7)	23 (13.8)
Medication
Antihypertensive therapy	202 (45.6)	81 (44.5)	121 (51.3)	0.17²	111 (44.4)	91 (54.2)	0.05²
Antiplatelet therapy	81 (18.3)	31 (17.0)	50 (21.2)	0.287²	44 (17.6)	37 (22.0)	0.262²
Hypoglycemic therapy	121 (27.3)	53 (29.1)	68 (28.9)	0.967²	71 (28.5)	50 (29.8)	0.783²
Infarct volume in mL	3.27 (0.58-24.24)	1.16 (0.05-7.88)	7.61 (1.53-63.41)	0.36¹	1.46 (0.13-7.93)	16.62 (2.51-103.09)	0.013¹
Time for stroke onset to intravenous rtPA infusion in min	170.05 (124-218.25)	182 (0-125)	167.5 (120-219.5)	0.528¹	173.5 (125-218)	166.5 (120-220)	0.306¹

¹Mann Whitney U test.

²χ² test.

Data are n (%)/median (25^th-75^th percentiles). D-ND: Delayed neurological deterioration; rtPA: Recombinant tissue plasminogen activator.

Citation: 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
URL: https://www.wjgnet.com/2220-315x/full/v14/i3/95540.htm
DOI: https://dx.doi.org/10.5493/wjem.v14.i3.95540