A total of 960 patients with AIS who underwent EVT were screened, and 796 patients who fulfilled the inclusion criteria were included in the study (Fig. 1). The mean age of the patients was 62.89 ± 12.22 years, and 566 (71.1%) were male. The median baseline NIHSS and ASPECTS/pc-ASPECTS scores were 16 and 9, respectively. Large-vessel occlusion in the anterior circulation was observed in 568 patients (71.4%). A total of 270 patients (33.9%) underwent IVT before EVT. The median OTP and OTR were 380 and 458 minutes, respectively. During the follow-up at 90 days, 465 (58.4%) patients had unfavorable functional outcomes.
Univariate analyses of patients with favorable and unfavorable outcomes
A comparison of the detailed characteristics of the patients with favorable and unfavorable outcomes is shown in Table 1. In the univariable analysis, patients with unfavorable outcomes were much older (65.07 ± 11.93 vs. 59.83 ± 11.98, p < 0.001), had higher proportions of diabetes (34.0% vs. 21.1%, p < 0.001), hyperlipidemia (69.5% vs. 42.0%, p < 0.001), previous stroke (29.5% vs. 20.2%, p = 0.003), posterior circulation lesion (32.9% vs. 22.7%, p = 0.002), general anesthesia (42.2% vs. 29.9%, p < 0.001), ICH (44.1% vs. 22.7%, p < 0.001), and sICH (17.8% vs. 1.8%, p < 0.001). However, there was a lower proportion of current smokers (35.7% vs. 45.6%, p = 0.005).
Table 1
Characteristics of patients with favorable outcome and unfavorable outcome
Factors
|
Total number
(n = 796)
|
Favorable outcome
(n = 331)
|
Unfavorable outcome
(n = 465)
|
P value
|
Demographics
|
|
Age, y, mean ± SD
|
62.89 ± 12.22
|
59.83 ± 11.98
|
65.07 ± 11.93
|
< 0.001*
|
Male, n (%)
|
566(71.1%)
|
256(77.3%)
|
310(66.7%)
|
< 0.001*
|
Vascular risk factors
|
|
Hypertension, n (%)
|
558(70.1%)
|
220(66.5%)
|
338(72.7%)
|
0.059
|
Diabetes, n (%)
|
228(28.6%)
|
70(21.1%)
|
158(34.0%)
|
< 0.001*
|
Hyperlipidemia, n (%)
|
462(58.0%)
|
139(42.0%)
|
323(69.5%)
|
< 0.001*
|
Current smoking, n (%)
|
317(39.8%)
|
151(45.6%)
|
166(35.7%)
|
0.005*
|
Atrial fibrillation, n (%)
|
259(32.5%)
|
95(28.7%)
|
164(35.3%)
|
0.051
|
Previous stroke, n (%)
|
204(25.6%)
|
67(20.2%)
|
137(29.5%)
|
0.003*
|
Baseline clinical assessment
|
|
Admission SBP (mmHg), mean ± SD
|
146 ± 33
|
143.55 ± 22.58
|
150.67 ± 24.15
|
< 0.001*
|
Admission DBP (mmHg), mean ± SD
|
83 ± 15
|
83.03 ± 14.43
|
85.27 ± 14.79
|
0.033*
|
Admission NIHSS, median (IQR)
|
16(9)
|
13(7)
|
18(12)
|
< 0.001*
|
Admission ASPECTS/pc-ASPECTS, median (IQR)
|
9(3)
|
9(2)
|
8(3)
|
0.006*
|
Laboratory test
|
|
FBG (mmol/L), median (IQR)
|
7.37(3.35)
|
6.89(2.54)
|
7.96(3.92)
|
< 0.001*
|
NLR, median (IQR)
|
5.87(6.42)
|
4.85(4.96)
|
6.57(7.21)
|
< 0.001*
|
PLR, median (IQR)
|
161.79(133.10)
|
153.90(113.05)
|
168.89(140.10)
|
0.002*
|
MLR, median (IQR)
|
0.30(0.21)
|
0.28(0.17)
|
0.32(0.25)
|
< 0.001*
|
Lesion location
|
|
|
|
0.002*
|
Anterior circulation, n (%)
|
568(71.4%)
|
256(77.3%)
|
312(67.1%)
|
|
Posterior circulation, n (%)
|
228(28.6%)
|
75(22.7%)
|
153(32.9%)
|
|
Stroke etiology
|
|
LAA, n (%)
|
479(60.2%)
|
210(63.4%)
|
269(57.8%)
|
0.088
|
CE, n (%)
|
281(35.3%)
|
103(31.1%)
|
178(38.3%)
|
Others, n (%)
|
36(4.5%)
|
18(5.4%)
|
18(3.9%)
|
Treatment
|
|
General anesthesia, n (%)
|
295(37.1%)
|
99(29.9%)
|
196(42.2%)
|
< 0.001*
|
OTP (min), median (IQR)
|
380(244)
|
389(254)
|
375(238)
|
0.775
|
OTR (min), median (IQR)
|
458(242.0)
|
450(237.0)
|
465(249.5)
|
0.507
|
IVT, n (%)
|
270(33.9%)
|
112(33.8%)
|
158(34.0%)
|
0.967
|
Clinical outcomes
|
|
|
|
|
ICH, n (%)
|
280(35.2%)
|
75(22.7%)
|
205(44.1%)
|
< 0.001*
|
sICH, n (%)
|
89(11.2%)
|
6(1.8%)
|
83(17.8%)
|
< 0.001*
|
*P < 0.05. SBP, systolic blood pressure; DBP, diastolic blood pressure; NIHSS, National Institute of Health Stroke Scale; ASPECTS, Alberta Stroke Program Early Computed Tomography Score; pc-ASPECTS, posterior circulation Alberta Stroke Program Early Computed Tomography Score; FBG, fast blood glucose; NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; MLR, monocyte-to-lymphocyte ratio; LAA, large artery atherosclerosis; CE, cardio embolism; OTP, time interval from symptoms onset to puncture; OTR, time interval from symptoms onset to recanalization; IVT, intravenous thrombolysis ICH, intracranial hemorrhage; sICH, symptomatic intracranial hemorrhage. |
The results showed that men were more likely to achieve favorable outcomes (77.3% vs. 66.7%, p < 0.001). In addition, patients with unfavorable outcomes also had higher baseline SBP (150.67 ± 24.15 mmHg vs. 143.55 ± 22.58 mmHg, p < 0.001), higher DBP (85.27 ± 14.79 mmHg vs. 83.03 ± 14.43 mmHg, p = 0.033), higher NIHSS score (median, 18 vs. 13, p < 0.001), lower ASPECTS/pc-ASPECTS score (median, 8 vs. 9, p = 0.006). For laboratory tests, patients in the unfavorable outcome group had higher FBG (median, 7.96 mmol/L vs. 6.89 mmol/L, p < 0.001), NLR (median, 6.57 vs. 4.85, p < 0.001), PLR (median, 168.89 vs. 153.90, p = 0.002), and MLR (median, 0.32 vs. 0.28, p < 0.001).
Effect of NLR, PLR, and MLR on functional outcomes
After adjusting for potential confounders (age, sex, diabetes, hyperlipidemia, atrial fibrillation, admission DBP, NIHSS, ASPECTS, FBG, lesion location, general anesthesia, and sICH), NLR (OR, 1.076; 95% CI, 1.037–1.117; p < 0.001), and PLR (OR, 1.001; 95% CI, 1.000-1.003; p = 0.045) were found as independent predictors of unfavorable outcomes. Nevertheless, MLR was not significantly associated with unfavorable outcomes (OR, 1.052; 95% CI, 0.954–2.365; p = 0.079) (Table 2).
Table 2
Multivariable analysis of NLR, PLR, MLR in predicting unfavorable outcomes at 90 days
Variable
|
β
|
SE
|
OR
|
95% CI
|
P value
|
NLR
|
Unadjusted
|
0.083
|
0.016
|
1.087
|
1.054
|
1.121
|
< 0.001*
|
|
Adjusted @
|
0.074
|
0.019
|
1.076
|
1.037
|
1.117
|
< 0.001*
|
PLR
|
Unadjusted
|
0.001
|
0.001
|
1.001
|
1.000
|
1.003
|
0.029*
|
|
Adjusted @
|
0.001
|
0.001
|
1.001
|
1.000
|
1.003
|
0.045*
|
MLR
|
Unadjusted
|
0.482
|
0.297
|
1.619
|
0.905
|
2.899
|
0.105
|
|
Adjusted @
|
0.407
|
0.232
|
1.502
|
0.954
|
2.365
|
0.079
|
*P < 0.05. @ Adjusting for age, sex, diabetes, hyperlipidemia, atrial fibrillation, admission DBP, NIHSS, ASPECTS/ pc-ASPECTS, FBG, lesion location, general anesthesia, and sICH. |
The areas under the receiver operating characteristic curves (AUC) of NLR, PLR, and MLR were 0.622 (95% CI, 0.583–0.661; p < 0.001), 0.564 (95% CI, 0.524–0.604; p = 0.002), and 0.576 (95% CI, 0.536–0.616; p < 0.001), respectively (Fig. 2).