Influencing factors analysis of rt-PA thrombolytic therapy and investigation of NLR predictive effect in ischemic stroke

ObjectiveTo study the prognostic factors of patients with ischemic stroke after emergency rt-PA thrombolytic therapy and explore the predictive value of neutrophil to lymphocyte ratio(NLR).

MethodsA total of 187 patients with ischemic stroke who received emergency rt-PA thrombolytic therapy were selected, the influencing factors that might be related to the prognosis of ischemic stroke were collected.NIHSS score and MRS score at different time points were followed up and collected.The NIHSS score before thrombolysis was subtracted from the NIHSS score 2 weeks after thrombolysis.ΔNIHSS < 2 was considered as poor prognosis group (65 patients), and Δ NIHSS ≥ 2 was considered as good prognosis group (122 patients).The MRS score before thrombolysis was subtracted from the MRS score 3 months after thrombolysis.ΔMRS < 3 was considered as poor prognosis group (68 patients), and ΔMRS ≥ 3 was considered as good prognosis group (119 patients).Independent sample T test, Spearman correlation analysis, linear regression analysis and ROC curve analysis were used, respectively.The factors influencing the prognostic effect of thrombolytic therapy and the possible predictive indicators were analyzed.

ResultsThe proportions of patients with hypertension and atrial fibrillation in the poor ΔNIHSS score group were higher than that in the better ΔNIHSS score group (P < 0.01 and P < 0.05).The levels of leukocyte, neutrophils and NLR in the poor ΔNIHSS score group were higher than those in the better ΔNIHSS score group (P < 0.01).The proportion of patients with atrial fibrillation in the poor ΔMRS score group was higher than that in the better ΔMRS score group (P < 0.05).The levels of leukocyte, neutrophils and NLR in the poor ΔMRS score group were higher than those in the better ΔMRS score group (P < 0.01).Further correlation analysis and linear regression analysis showed that NLR was significantly associated with ΔNIHSS score (b=-0.173, t=2.46, P < 0.05) and ΔMRS score (b=0.072, t=2.01, P < 0.05) after thrombolysis.ROC curve analysis showed that NLR could be used as the predictor of ΔNIHSS (AUC=0.595, P < 0.05, the optimal cutoff value was 5.169) and ΔMRS (AUC=0.618, P < 0.05, the optimal cutoff value was 6.228).

ConclusionsNLR level before thrombolytic therapy is an independent factor which influencing the prognosis of patients with ischemic stroke after rt-PA thrombolytic therapy, and it can be used as a potential reference index to predict the efficacy of thrombolytic therapy.