Neutrophil-to-lymphocyte ratio, hyperglycemia, and outcomes in ischemic stroke patients treated with intravenous thrombolysis

Introduction Increased neutrophil-to-lymphocyte ratio (NLR) and hyperglycemia on admission are associated with poor outcomes in acute ischemic stroke (AIS) patients. We sought to evaluate the combined effect of increased NLR and hyperglycemia on the prognosis of ischemia stroke treated with intravenous thrombolysis (IVT). Methods Patients with acute ischemic stroke receiving IVT treatment were prospectively enrolled. All participants were followed for 3 months. According to the levels of NLR and blood glucose, patients were categorized into four groups: high NLR or nonhigh NLR with or without hyperglycemia. The associations between NLR values with or without hyperglycemia and outcomes of stroke after thrombolysis were assessed by multivariable logistic regression analysis. Results Among the 381 stroke patients (median age 68 years, 61.68% man) included, 155 (40.68%) had a poor outcome (modified Rankin Scale score 3-6) during 3 months. After multivariate adjustment, high NLR with hyperglycemia increased the risk of 3-month poor outcome (OR = 4.42; 95% CI, 2.13-9.16), early neurological deterioration (END) (OR = 4.81; 95% CI, 2.08-11.12), and 3-month mortality (OR = 6.56; 95% CI, 1.92-22.40). A significant multiplicative interaction of NLR and blood glucose on 3-month poor outcome in ischemic stroke patients after thrombolysis was observed. Conclusions Ischemic stroke patients with concurrent high NLR and hyperglycemia increased risks of END, 3-month poor outcome, and mortality after thrombolysis.