Neutrophil-To-Lymphocyte Ratio (NLR) is a proven marker of acute systemic inflammation in various disease states including acute ischemic stroke (AIS). Its role in prognostication of AIS patients and association with intracranial hemorrhage post thrombectomy for large vessel occlusion (LVO) strokes has been documented. We evaluated the utility of NLR in the detection of LVO stroke.

A retrospective review of AIS database at our CSC. Patients with AIS diagnosis were included in the study. Demographics (Age, Sex) clinical characteristics (NIHSS score, TLKW-Time from last known well to arrival), and radiological features (Presence or absence of LVO was confirmed using CTA/MRA/DSA) were recorded. Statistical analysis (sensitivity, specificity, positive and negative predictive value) were performed.

A total of 1241 AIS were included. Mean age and NIHSS score were 69 ±15 and 9 ±8, respectively. 47% (585) were females. Mean Neutrophil-to-lymphocyte (NLR) ratio was 6.2 ±7.5 and median was 3.9 (2.3-7.1). LVO was recognized in 30.1% (347) patients [Internal carotid artery-40% (139), MCA-M1-54.5% (189) and Basilar Artery-5.5% (19)]. Remainder of the patients were negative for any intracranial vessel occlusion on CTA or MRA or DSA. Among LVO, mean NIHSS was 16 ±8 and mean and median NLR were 8.1 ±8.4 and 5.7 (3.1-10.2). Mean (8.1 ±8.4 vs 5.5 ±7, p=<0.001) and Median [5.7 (3-10.2) vs 3.5 (2.2-6), p=<0.001] NLR were higher among LVO strokes compared to non-LVO strokes. NLR thresholds for LVO detection have been tabulated.

NLR Thresholds for LVO.

Point of care application of Neutrophil-To-Lymphocyte Ratio in the pre-hospital setting may facilitate direct triage of LVO patients to thrombectomy capable centers.