Can the Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio, and C-Reactive Protein-to-Albumin Ratio Always Predict Mortality in Acute Ischemic Stroke Patients Undergoing Mechanical Thrombectomy? A Single-Center Experience.

Abstract

Background: Predicting mortality in patients with acute ischemic stroke who need endovascular treatment (EVT) has previously been shown to be related to inflammation. In this study, we aimed to examine the effects of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and hypersensitive C-reactive protein-to-albumin ratio (CAR) values on mortality and hemorrhagic transformation. Methods: A total of 225 adult patients who underwent EVT between 2022 and 2024 were retrospectively analyzed. The presence of intracranial hemorrhage (ICH) after the procedure; good and poor clinical outcomes according to modified Rankin Scores; mortality status; and NLR, PLR, and CAR values were collected. Results: The average age of the patients was 66.95 ± 12.74 years, and 133 (59.1%) patients were male. Thirty-eight (30.4%) patients had symptomatic ICH. While 164 (72.9%) patients had a poor outcome, 80 (35.6%) patients died. There was a correlation between the NLR and PLR values and symptomatic ICH (p = 0.013, 0.009, respectively) in the univariate analysis, but this relationship was not found in the multivariate analyses (p: 0.212 and p: 0.459). No statistically significant relationship was observed between the CAR and symptomatic ICH and mortality (p = 0.784, 0.079, respectively). When the laboratory data were compared according to the mortality status, the NLR and PLR were observed to be statistically significantly higher in the patients with mortality (p < 0.001, 0.005, respectively) in univariate analyses. But, as a result, the NLR, PLR, and CAR were not associated with ICH and mortality according to the multivariable logistic regression analysis. Conclusions: Our findings highlight the need to better understand the post-stroke immune response. Our study demonstrated that the NLR, PLR, and CAR were not associated with ICH and mortality according to the multivariable logistic regression analysis.