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Correlation of Systemic Inflammatory Index and Neutrophil Platelet Ratio with Intracranial Haemorrhage and Mortality After Endovascular Treatment Due to Acute Ischaemic Stroke

Year 2024, Volume: 46 Issue: 4, 510 - 520, 16.07.2024
https://doi.org/10.20515/otd.1463965

Abstract

Many studies in recent years have shown that systemic and local inflammatory responses following various diseases are important markers of tissue damage. We aimed to investigate the correlation of systemic inflamatory index and neutrophil platelet ratio with intracranial haemorrhage and mortality in patients undergoing endovascular treatment due to ischaemic stroke. Between 2022 and 2024, patients who hospitalised in the Antalya Training and Research Hospital Neurology intensive care unit after endovascular treatment were screened. Patients over 18 years of age with a door-needle time of less than 24 hours and who underwent endovascular treatment for successful internal carotid artery ICA, MCA, and basilar artery occlusion due to acute ischaemic stroke were included in the study. A total of 133 patients were included. intracranial haemorrhage was observed in 59 (44.4%) patients, and exitus developed in 38 (28.6%) patients. There was a correlation between the development of intracranial haemorrhage and systemic inflamatory index and neutrophil platelet ratio. A statistically significant difference was observed between the neutrophil platelet ratio and systemic inflamatory index median values according to mortality status, and neutrophil platelet ratio values were higher in patients who developed exitus. In conclusion, our findings indicate the correlation of systemic inflamatory index and neutrophil platelet ratio independently with intracranial haemorrhage and mortality in patients with endovascular treatment. These noninvasive and cost-effective inflammatory markers may constitute a good biomarker for intracranial haemorrhage and mortality after endovascular treatment. In order to confirm these findings, prospective studies with a larger population of patients are needed.

References

  • 1. Broderick JP, Berkhemer OA, Palesch YY, et al. Endovascular therapy is effective and safe for patients with severe ischemic stroke: pooled analysis of interventional management of stroke III and multicenter randomized clinical trial of endovascular therapy for acute ischemic stroke in the Netherlands data. Stroke. 2015;46:3416–22.
  • 2. Bektaş H, Çabalar M, Topçuoğlu M, et al. Endovascular treatment in acute ischemic stroke: What has changed over the last one year? Akut İskemik İnmede Endovasküler Tedavi: Son Bir Yilda Ne Deǧişti?. Turk Beyin Damar Hast Derg. 2016;22:1
  • 3. Badhiwala JH, Nassiri F, Alhazzani W, et al. Endovascular thrombectomy for acute ischemic stroke: a meta-analysis. JAMA. 2015;314:1832–43.
  • 4. Tang G, Cao Z, Luo Y, et al. Prognosis associated with asymptomatic intracranial hemorrhage after acute ischemic stroke: a systematic review and meta-analysis. J Neurol, 2022;269(7):3470-81.
  • 5. Ma L, Wang DF, Li ZQ, et al. Risk Factors for Intracranial Hemorrhage Transformation and Poor Prognosis after EVT for Acute Vessel Occlusion Stroke. medRxiv, 2023;05.
  • 6. 6.Suzuki Y, Nagai N, Umemura K. A review of the mechanisms of blood-brain barrier permeability by tissue-type plasminogen activator treatment for cerebral ischemia. Front Cell Neurosci. 2016;10:2.
  • 7. Lattanzi S, Norata D, Divani AA, et al. Systemic Inflammatory Response Index and Futile Recanalization in Patients with Ischemic Stroke Undergoing Endovascular Treatment. Brain Sciences. 2021;11(9):1164.
  • 8. Gong P, Liu Y, Gong Y, et al. The association of neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and lymphocyte to monocyte ratio with post-thrombolysis early neurological outcomes in patients with acute ischemic stroke. J Neuroinflammation. 2021;18(1):51.
  • 9. Pikija S, Sztriha LK, Killer-Oberpfalzer M, et al. Neutrophil to lymphocyte ratio predicts intracranial hemorrhage after endovascular thrombectomy in acute ischemic stroke. J Neuroinflammation. 2018;15(1):319.
  • 10. Hou D, Wang C, Luo Y, et al. Systemic immune-inflammation index (SII) but not platelet-albumin-bilirubin (PALBI) grade is associated with severity of acute ischemic stroke (AIS). Int J Neurosci. 2021;131(12):1203–1208.
  • 11. Yang Y, Han Y, Sun W, et al. Increased systemic immune-inflammation index predicts hemorrhagic transformation in anterior circulation acute ischemic stroke due to large-artery atherosclerotic. Int J Neurosci. 2023;133(6):629-635.
  • 12. Li BH, Wang LR, Huang J. et al. Predictive role of neutrophil-to-platelet ratio in futile recanalization of patients after endovascular therapy. Biomark Med., 2024;184(4):137-143.
  • 13. He W, Ruan Y, Yuan C, et al. High Neutrophil-to-Platelet Ratio Is Associated With Hemorrhagic Transformation in Patients With Acute Ischemic Stroke. Front. Neurol. 2019;10:1310.
  • 14. Hacke W, Kaste M, Fieschi C, et al. Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II): Second European-Australasian Acute Stroke Study Investigators. Lancet. 1998; 352:1245–1251.
  • 15. Berger C, Fiorelli M, Steiner T, et al. Hemorrhagic transformation of ischemic brain tissue: asymptomatic or symptomatic?. Stroke. 2001;32(6):1330-1335.
  • 16. Lattanzi S, Cagnetti C, Provinciali L, Silvestrini M. Neutrophil-to-lymphocyte ratio predicts the outcome of acute intracerebral hemorrhage. Stroke. 2016;47:1654–7. 17. Switonska M, Piekus-Slomka N, Slomka A, et al. Neutrophil-to-lymphocyte ratio and symptomatic hemorrhagic transformation in ischemic stroke patients undergoing revascularization. Brain Sci. 2020;10:771.
  • 17. Lattanzi S, Cagnetti C, Provinciali L, Silvestrini M. Neutrophil-to-lymphocyte ratio and neurological deterioration following acute cerebral hemorrhage. Oncotarget. 2017;8:57489–94.
  • 18. Rosell A, Cuadrado E, Ortega-Aznar A, et al. MMP-9-positive neutrophil infiltration is associated to blood-brain barrier breakdown and basal lamina type IV collagen degradation during hemorrhagic transformation after human ischemic stroke. Stroke. 2008;39(4):1121-6.
  • 19. Shaik NF, Regan RF, Naik UP. Platelets as drivers of ischemia/reperfusion injury after stroke. Blood Adv. 2021;5(5):1576–1584.
  • 20. Cheng XD, Zhang CX, Zhang Q, et al. Predictive Role of Pre-Thrombolytic Neutrophil-Platelet Ratio on Hemorrhagic Transformation After Intravenous Thrombolysis in Acute Ischemic Stroke. Clin Appl Thromb Hemost. 2024;30.
  • 21. Acar BA, Acar T, Vatan MB, et al. Predictive value of systemic immune-inflammation index for cerebral reperfusion and clinical outcomes in patients with acute ischemic stroke undergoing endovascular treatment. Eur Rev Med Pharmacol Sci, 2022;26(16):5718-28.
  • 22. Yi HJ, Sung JH, Lee DH. Systemic inflammation response index and systemic immune-inflammation index are associated with clinical outcomes in patients treated with mechanical thrombectomy for large artery occlusion. World neurosurg. 2021;153:e282–9.
  • 23. Yang Y, Cui T, Bai X, et al. Association between systemic immune-inflammation index and symptomatic intracranial hemorrhage in acute ischemic stroke patients undergoing endovascular treatment. Curr neurovasc Res, 2022;19(1):83-91.
  • 24. Hao Y, Zhang Z, Zhang H, et al. Risk of intracranial hemorrhage after endovascular treatment for acute ischemic stroke: systematic review and meta-analysis. Interv Neurol. 2017;6:57–64.
  • 25. Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387(10029):1723-1731.

Sistemik İnflamatuar İndeks ve Nötrofil Platelet Oranının Akut İskemik İnme Nedeniyle Endovasküler Tedavi Sonrası İntrakranial Hemaroji Ve Mortaliteyle İlişkisi

Year 2024, Volume: 46 Issue: 4, 510 - 520, 16.07.2024
https://doi.org/10.20515/otd.1463965

Abstract

Son yıllarda yapılan birçok çalışma, çeşitli hastalıkları takiben oluşan sistemik ve lokal enflamatuar yanıtların doku hasarının önemli belirteçleri olduğunu göstermiştir. Bu çalışmada iskemik inme nedeniyle endovasküler tedavi uygulanan hastalarda sistemik inflamatuvar indeks ve nötrofil platelet oranının intrakranial hemoraji ve mortalite ile ilişkisini araştırmayı amaçladık. 2022-2024 yılları arasında Antalya Eğitim ve Araştırma Hastanesi Nöroloji yoğun bakım ünitesinde endovasküler tedavi sonrası yatan hastalar tarandı. Akut iskemik inme nedeniyle başarılı ICA, MCA ve baziler arter oklüzyonu için endovasküler tedavi uygulanan ve kapı-iğne süresi 24 saatten az olan 18 yaşından büyük hastalar çalışmaya dahil edildi. Toplam 133 hasta çalışmaya dahil edildi. 59 (%44,4) hastada intrakranial kanama gözlendi ve 38 (%28,6) hastada exitus gelişti. İntrakranial hemoraji gelişimi ile sistemik inflamatuvar indeks ve nötrofil trombosit oranı arasında korelasyon vardı. Mortalite durumuna göre nötrofil platelet oranı ve sistemik inflamatuvar indeks medyan değerleri arasında istatistiksel olarak anlamlı bir fark gözlendi ve exitus gelişen hastalarda nötrofil platelet oranı değerleri daha yüksekti. Bulgularımız endovasküler tedavi uygulanan hastalarda sistemik inflamatuvar indeks ve nötrofil platelet oranının bağımsız olarak intrakranial hemoraji ve mortalite ile ilişkili olduğunu göstermektedir. Bu noninvaziv ve uygun maliyetli inflamatuvar belirteçler, endovasküler tedavi sonrası intrakranial kanama ve mortalite için iyi bir biyobelirteç olabilir. Bu bulguları doğrulamak için daha geniş bir hasta popülasyonuyla yapılacak prospektif çalışmalara ihtiyaç vardır.

Ethical Statement

No conflict of interest was declared by the authors.

Supporting Institution

The authors declared that this study received no financial support.

Thanks

None

References

  • 1. Broderick JP, Berkhemer OA, Palesch YY, et al. Endovascular therapy is effective and safe for patients with severe ischemic stroke: pooled analysis of interventional management of stroke III and multicenter randomized clinical trial of endovascular therapy for acute ischemic stroke in the Netherlands data. Stroke. 2015;46:3416–22.
  • 2. Bektaş H, Çabalar M, Topçuoğlu M, et al. Endovascular treatment in acute ischemic stroke: What has changed over the last one year? Akut İskemik İnmede Endovasküler Tedavi: Son Bir Yilda Ne Deǧişti?. Turk Beyin Damar Hast Derg. 2016;22:1
  • 3. Badhiwala JH, Nassiri F, Alhazzani W, et al. Endovascular thrombectomy for acute ischemic stroke: a meta-analysis. JAMA. 2015;314:1832–43.
  • 4. Tang G, Cao Z, Luo Y, et al. Prognosis associated with asymptomatic intracranial hemorrhage after acute ischemic stroke: a systematic review and meta-analysis. J Neurol, 2022;269(7):3470-81.
  • 5. Ma L, Wang DF, Li ZQ, et al. Risk Factors for Intracranial Hemorrhage Transformation and Poor Prognosis after EVT for Acute Vessel Occlusion Stroke. medRxiv, 2023;05.
  • 6. 6.Suzuki Y, Nagai N, Umemura K. A review of the mechanisms of blood-brain barrier permeability by tissue-type plasminogen activator treatment for cerebral ischemia. Front Cell Neurosci. 2016;10:2.
  • 7. Lattanzi S, Norata D, Divani AA, et al. Systemic Inflammatory Response Index and Futile Recanalization in Patients with Ischemic Stroke Undergoing Endovascular Treatment. Brain Sciences. 2021;11(9):1164.
  • 8. Gong P, Liu Y, Gong Y, et al. The association of neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, and lymphocyte to monocyte ratio with post-thrombolysis early neurological outcomes in patients with acute ischemic stroke. J Neuroinflammation. 2021;18(1):51.
  • 9. Pikija S, Sztriha LK, Killer-Oberpfalzer M, et al. Neutrophil to lymphocyte ratio predicts intracranial hemorrhage after endovascular thrombectomy in acute ischemic stroke. J Neuroinflammation. 2018;15(1):319.
  • 10. Hou D, Wang C, Luo Y, et al. Systemic immune-inflammation index (SII) but not platelet-albumin-bilirubin (PALBI) grade is associated with severity of acute ischemic stroke (AIS). Int J Neurosci. 2021;131(12):1203–1208.
  • 11. Yang Y, Han Y, Sun W, et al. Increased systemic immune-inflammation index predicts hemorrhagic transformation in anterior circulation acute ischemic stroke due to large-artery atherosclerotic. Int J Neurosci. 2023;133(6):629-635.
  • 12. Li BH, Wang LR, Huang J. et al. Predictive role of neutrophil-to-platelet ratio in futile recanalization of patients after endovascular therapy. Biomark Med., 2024;184(4):137-143.
  • 13. He W, Ruan Y, Yuan C, et al. High Neutrophil-to-Platelet Ratio Is Associated With Hemorrhagic Transformation in Patients With Acute Ischemic Stroke. Front. Neurol. 2019;10:1310.
  • 14. Hacke W, Kaste M, Fieschi C, et al. Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II): Second European-Australasian Acute Stroke Study Investigators. Lancet. 1998; 352:1245–1251.
  • 15. Berger C, Fiorelli M, Steiner T, et al. Hemorrhagic transformation of ischemic brain tissue: asymptomatic or symptomatic?. Stroke. 2001;32(6):1330-1335.
  • 16. Lattanzi S, Cagnetti C, Provinciali L, Silvestrini M. Neutrophil-to-lymphocyte ratio predicts the outcome of acute intracerebral hemorrhage. Stroke. 2016;47:1654–7. 17. Switonska M, Piekus-Slomka N, Slomka A, et al. Neutrophil-to-lymphocyte ratio and symptomatic hemorrhagic transformation in ischemic stroke patients undergoing revascularization. Brain Sci. 2020;10:771.
  • 17. Lattanzi S, Cagnetti C, Provinciali L, Silvestrini M. Neutrophil-to-lymphocyte ratio and neurological deterioration following acute cerebral hemorrhage. Oncotarget. 2017;8:57489–94.
  • 18. Rosell A, Cuadrado E, Ortega-Aznar A, et al. MMP-9-positive neutrophil infiltration is associated to blood-brain barrier breakdown and basal lamina type IV collagen degradation during hemorrhagic transformation after human ischemic stroke. Stroke. 2008;39(4):1121-6.
  • 19. Shaik NF, Regan RF, Naik UP. Platelets as drivers of ischemia/reperfusion injury after stroke. Blood Adv. 2021;5(5):1576–1584.
  • 20. Cheng XD, Zhang CX, Zhang Q, et al. Predictive Role of Pre-Thrombolytic Neutrophil-Platelet Ratio on Hemorrhagic Transformation After Intravenous Thrombolysis in Acute Ischemic Stroke. Clin Appl Thromb Hemost. 2024;30.
  • 21. Acar BA, Acar T, Vatan MB, et al. Predictive value of systemic immune-inflammation index for cerebral reperfusion and clinical outcomes in patients with acute ischemic stroke undergoing endovascular treatment. Eur Rev Med Pharmacol Sci, 2022;26(16):5718-28.
  • 22. Yi HJ, Sung JH, Lee DH. Systemic inflammation response index and systemic immune-inflammation index are associated with clinical outcomes in patients treated with mechanical thrombectomy for large artery occlusion. World neurosurg. 2021;153:e282–9.
  • 23. Yang Y, Cui T, Bai X, et al. Association between systemic immune-inflammation index and symptomatic intracranial hemorrhage in acute ischemic stroke patients undergoing endovascular treatment. Curr neurovasc Res, 2022;19(1):83-91.
  • 24. Hao Y, Zhang Z, Zhang H, et al. Risk of intracranial hemorrhage after endovascular treatment for acute ischemic stroke: systematic review and meta-analysis. Interv Neurol. 2017;6:57–64.
  • 25. Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387(10029):1723-1731.
There are 25 citations in total.

Details

Primary Language English
Subjects Clinical Sciences (Other)
Journal Section ORİJİNAL MAKALE
Authors

Firdevs Ezgi Uçan Tokuç 0000-0002-0347-6026

Şennur Delibaş Katı 0000-0002-4619-693X

Publication Date July 16, 2024
Submission Date April 2, 2024
Acceptance Date May 28, 2024
Published in Issue Year 2024 Volume: 46 Issue: 4

Cite

Vancouver Uçan Tokuç FE, Delibaş Katı Ş. Correlation of Systemic Inflammatory Index and Neutrophil Platelet Ratio with Intracranial Haemorrhage and Mortality After Endovascular Treatment Due to Acute Ischaemic Stroke. Osmangazi Tıp Dergisi. 2024;46(4):510-2.


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