High platelet to lymphocyte ratio as a risk factor for poor outcome in acute ischemic stroke patient

Abstract

Background & Objective: Stroke is one of the leading causes of death and disability worldwide. The incidence of ischemic stroke in the anterior circulation is greater in the middle cerebral artery (MCA) distribution. A high level of platelet to lymphocyte ratio (PLR) has been widely studied as a predictor of poor outcomes in various conditions, such as cardiovascular disease and malignancy. However, the significance of PLR as a predictor of outcome in stroke patients, especially the ischemic type, are still uncertain. This study aimed to determine whether increased PLR was a risk factor for poor outcomes in acute ischemic stroke patients. Methods: This is a single-center case-control study. The data of acute ischemic stroke patients in MCA territory admitted from January 2019 to April 2020, who met the inclusion and exclusion criteria, were collected. The stroke outcome was defined by NIHSS upon discharge. The Control group was those with NIHSS <10 and Case group with NIHSS≥10 or death. The determinant of this study as a risk factor was PLR with a cut-off ratio of 148. Results: Ninety-three subjects with 47 cases (mean age 65.51±11.73) and 46 controls (mean age 57.78±11.39) were collected. In adjusted multivariate analysis, independent risk factor was high PLR (p=0.008) and high CRP (p=0.008). Meanwhile, in bivariate analysis, significant risk factors for poor outcome of acute ischemic stroke were high PLR (odds ratio [OR], 4.88; 95% confidence interval [CI], 2.02-11.73, p<0.01), elderly (OR, 4.02; 95% CI, 1.48-10.87, p=0.05), embolic stroke type (OR, 2.85; 95% CI, 1.21-6.76, p=0.01), and high CRP (OR, 5.13; 95% CI,2.09-12.57, p<0.01). Conclusions: High PLR is an independent risk factor for poor outcomes in acute MCA ischemic stroke.