Neutrophil-to-lymphocyte Ratio Predicts Prognosis After Endovascular Thrombectomy in Acute Ischemic Stroke: A...

The neutrophil-to-lymphocyte ratio (NLR) is an inflammatory biomarker that may help predict outcomes after stroke. This meta-analysis examined the association of NLR with symptomatic intracranial hemorrhage (sICH) and mortality in patients with acute ischemic stroke undergoing endovascular thrombectomy (EVT).

We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials for studies published from database inception through 2024. Studies reporting predictors of sICH and mortality after EVT were included. This meta-analysis focused on the prognostic value of NLR for these outcomes. Pooled analyses were performed using Review Manager (RevMan) 5.3.

Seventeen cohort studies involving 8,392 patients were included. Pooled analyses demonstrated a significant association between higher NLR and sICH (OR = 1.07, 95% CI 1.03-1.11; I² = 70%), as well as mortality (OR = 1.09, 95% CI 1.04-1.14; I² = 79%). These findings suggest that NLR may provide additional prognostic information when used alongside established clinical predictors.

Higher NLR was associated with increased risks of sICH and mortality following EVT and may offer prognostic information beyond neurological assessment alone. However, these findings should be interpreted with caution because of substantial heterogeneity, variable NLR cutoffs across studies, and the predominance of retrospective evidence. Prospective validation is warranted.

In patients with acute ischemic stroke treated with EVT, higher NLR was associated with increased risks of sICH and mortality. As a routinely available blood-based biomarker, NLR may complement established clinical predictors in post-EVT risk stratification. Prospective studies incorporating standardized and serial NLR measurements are needed to validate these findings.