Predictive value of neutrophil to apolipoprotein A1 ratio in patients with acute ischemic stroke

The neutrophil-to-apolipoprotein A1 ratio (NAR) has emerged as a possible prognostic biomarker in different medical conditions. Nonetheless, the predictive potential of NAR in determining the 3-month prognosis of acute ischemic stroke (AIS) patients who undergo intravenous thrombolysis has yet to be fully acknowledged. In this study, 196 AIS patients with recombinant tissue plasminogen activator (r-tPA) and 133 healthy controls were included. Meanwhile, we incorporated a total of 386 non-thrombolytic AIS patients. The AIS patients with r-tPA were divided into four groups based on quartiles of NAR. The association between NAR and the 3-month prognosis was evaluated through univariate and multivariate regression analyses. Additionally, subgroup analyses were conducted to investigate the predictive value of NAR in different patient populations. Adverse outcomes were defined as a modified Rankin Scale (mRS) score of 3-6. The study findings revealed a significant association between elevated NAR levels and poor prognosis in AIS patients. In the highest quartile of NAR levels (Q4), after controlling for age, gender, admission The National Institutes of Health Stroke Scale score, blood urea nitrogen, and stroke subtypes, the odds ratio (OR) for adverse outcomes at 3-months was 13.314 (95% CI: 2.878-61.596, p = 0.001). An elevated NAR value was found to be associated with a poor prognosis in AIS patients, regardless of whether they received r-tPA treatment or not. The new model, which incorporating NAR into the conventional model, demonstrated a statistically significant improvement in discriminatory power and risk reclassification for 3-month poor outcomes in AIS patients treated with r-tPA. The new model exhibited a categorical Net Reclassification Index (NRI) (p = 0.035) of 12.9% and an Integrated Discrimination Improvement (IDI) (p = 0.013) of 5.2%. Subgroup analyses indicated that the predictive value of NAR differed across stroke subtypes. NAR is a potential biomarker for predicting the prognosis of AIS patients. The clinical implications of our findings are significant, as early identification and intervention in high-risk patients can improve their outcomes. However, further studies are required to validate our results and elucidate the underlying mechanisms of the association between NAR and poor prognosis in AIS patients.