Inflammatory biomarkers may be associated with poor outcomes after mechanical thrombectomy
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Published on: January 28, 2020
Hong Wang1, Xiaobing Tian1, Zhangyuan Liao1
1Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, China.
Background:
Mechanical thrombectomy (MT) has become the mainstay of treatment for acute ischemic stroke (AIS) recently. This case-control study aimed to identify the pivotal role of inflammation in the prognosis of AIS patients after MT.
Methods:
Altogether, 70 AIS patients who underwent MT were retrospectively recruited for this study. Receiver operating characteristic analysis was performed to demonstrate the sensitivity and specificity of the inflammatory variables for predicting prognosis. A meta-analysis was performed to pool the published results together. Stata software was used for analysis.
Results:
There was no differences in pre-MT inflammatory biomarkers between patients who survived and those who died, as well as patients with modified Rankin Scale (mRS) 0-2 and mRS ≥ 3. In contrast, post-MT C-reactive protein (CRP) levels might be a potential parameter to predict death after thrombectomy [area under the curve (AUC), 95%confidence interval (CI), 0.737, 0.587-0.887; p = 0.005; optimal cutoff value = 4.565]. Moreover, post-MT monocyte count might be an appropriate parameter to predict poor long-term prognosis after thrombectomy (AUC, 95%CI, 0.704, 0.575-0.833; p = 0.017; optimal cutoff value = 0.345). A meta-analysis revealed that the pre-MT inflammatory indices, including white blood cell count (weighted mean difference, 95%CI, 1.32, 1.01-1.63), neutrophil count (1.23, 0.95-1.51), monocyte count (0.05, 0.02-0.09), neuthrophil-to-lymphocyte ratio (2.42, 1.98-2.87) and platelet-to-lymphocyte ratio (24.65, 7.99-41.32), were higher in patients with 3-month mRS ≥ 3, and the lymphocyte count (-0.31,-0.43 to -0.18) was lower in this cohort.
Conclusions:
Inflammatory indices were significantly associated with the prognosis of patients undergoing MT, especially post-MT CRP and monocyte count, which can predict long-term outcomes.
Insights
Inflammation plays a key role in acute ischemic stroke (AIS) prognosis after mechanical thrombectomy (MT). Post-procedure C-reactive protein and monocyte counts effectively predict patient outcomes and long-term prognosis.
Area of Science:
- Neurology
- Cardiovascular Diseases
- Inflammation Research
Background:
- Mechanical thrombectomy (MT) is a primary treatment for acute ischemic stroke (AIS).
- The role of inflammation in AIS prognosis following MT requires further investigation.
- This study explores inflammation's impact on AIS patient outcomes after MT.
Purpose of the Study:
- To identify key inflammatory markers predicting prognosis in AIS patients undergoing MT.
- To evaluate the diagnostic accuracy of inflammatory indices for patient outcomes.
- To synthesize existing evidence through meta-analysis.
Main Methods:
- Retrospective analysis of 70 AIS patients who underwent MT.
- Receiver operating characteristic (ROC) analysis to assess predictive values of inflammatory markers.
- Meta-analysis to pool data and confirm findings.
Main Results:
- No significant difference in pre-MT inflammatory markers between survival and mortality groups.
- Post-MT C-reactive protein (CRP) levels can predict death (AUC: 0.737).
- Post-MT monocyte count predicts poor long-term prognosis (AUC: 0.704).
- Meta-analysis showed elevated pre-MT white blood cell count, neutrophil count, monocyte count, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio in patients with poor outcomes (3-month mRS ≥ 3).
- Lower lymphocyte counts were observed in patients with poorer outcomes.
Conclusions:
- Inflammatory indices are significantly associated with prognosis in patients undergoing MT.
- Post-MT CRP and monocyte counts are valuable predictors of long-term outcomes.
- Inflammation markers offer potential for risk stratification and treatment monitoring in AIS patients post-MT.
