Prognostic value of a composite NLR-PLR index for neurological recovery after EVT in AIS-LVO patients

To evaluate whether a combined neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) index enhances the prediction of short-term functional outcomes in patients with anterior circulation large vessel occlusion (AIS-LVO) undergoing endovascular therapy (EVT).

We retrospectively enrolled 259 AIS-LVO patients who underwent EVT between September 2022 and September 2024. NLR and PLR were dichotomized using optimal ROC-derived cutoff values (NLR > 4.783, PLR > 185.931) and assigned binary scores. These were summed to construct a composite index ranging from 0 to 2, and patients were grouped into Y1-Y4 categories. The primary outcome was 90-day functional outcome, measured by modified Rankin Scale (mRS).

The combined index outperformed NLR or PLR alone in predicting 90-day outcomes (AUC = 0.676). Patients in Y4 (both high NLR and PLR) had the highest rate of unfavorable outcomes, while Y1 (both low) had the lowest. Logistic regression confirmed independent associations of both NLR and PLR with prognosis.

A composite NLR-PLR index may help to stratify short-term functional prognosis in AIS-LVO patients after EVT, potentially supporting individualized risk assessment in clinical settings.The combined index formed by NLR and PLR groups may provide an improved prediction of short-term functional outcomes for AIS-LVO patients after thrombectomy. Stratification by Y1-Y4 groupings enables clinicians to identify high-risk patients more precisely and tailor early interventions accordingly.