ORIGINAL RESEARCH article
Front. Neurol.
Sec. Neurological Biomarkers
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1542889
This article is part of the Research TopicGenetic Insights and Diagnostic Innovations in Cerebrovascular and Cerebrospinal Fluid DisordersView all 6 articles
Values of Lymphocyte-Related Ratios in Predicting the Clinical Outcome of Acute Ischemic Stroke Patients Receiving Intravenous Thrombolysis Based on Different Etiologies
Provisionally accepted
- 1Kunming Medical University, Kunming, China
- 2Department of Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
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Background: While neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) have been associated with acute ischemic stroke (AIS) outcomes, their differential predictive value across etiological subtypes (TOAST classification) in thrombolysis-treated patients remains underexplored.In this retrospective cohort study, we analyzed 381 AIS patients receiving intravenous thrombolysis. Hematological indices were calculated from prethrombolysis. Using multivariable logistic regression adjusted for age, NIHSS, and comorbidities, we assessed associations between baseline ratios and 90-day unfavorable outcomes (mRS 3-6). Receiver operating characteristic (ROC) analysis was used to determine optimal cutoffs stratified by TOAST subtypes.Results: A total of 381 patients were included in the study. NLR showed superior predictive performance: large-artery atherosclerosis: AUC=0.702 (aOR=1.35, 95%CI=1.14-1.61, P=0.001), small-artery occlusion: AUC=0.750 (aOR=1.51, 95%CI=1.08-2.10, P=0.015), cardioembolic stroke: AUC=0.679 (aOR=1.82, 95%CI=1.07-3.10, P=0.028). LMR showed predictive value only in large-artery atherosclerosis (AUC=0.632, P=0.004). Optimal NLR cutoffs: 3.19 (large-artery), 3.94 (small-artery), 3.17 (cardioembolic stroke).Conclusions: NLR emerged as a robust, subtype-specific predictor of postthrombolysis outcomes, particularly in atherosclerotic stroke variants. These findings supported NLR's clinical utility for risk stratification in thrombolysis-eligible AIS patients.
Keywords: Stroke, etiology, thrombolysis, Neutrophil, lymphocyte, Outcome
Received: 25 Feb 2025; Accepted: 22 Apr 2025.
Copyright: © 2025 Li, Chen, Wang, Zhao, Lei, Gu, Zhu and Deng. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Chunyan Lei, Department of Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan Province, China
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