What question did this study set out to answer?

The study aims to evaluate the association between admission neutrophil-to-lymphocyte ratio (NLR) and 90-day functional outcomes in patients with large vessel occlusion stroke treated with endovascular thrombectomy.

March 14, 2026BMC Neurology0 citationsOpen Access

Association between neutrophil-to-lymphocyte ratio and functional outcomes in patients with large vessel occlusion stroke treated with endovascular thrombectomy

LLLiang Long STSizhi Tang LCLongqiong Chen

Key Points

The study aims to evaluate the association between admission neutrophil-to-lymphocyte ratio (NLR) and 90-day functional outcomes in patients with large vessel occlusion stroke treated with endovascular thrombectomy.
Conducted a retrospective cohort study of LVO stroke patients undergoing EVT from January 2019 to December 2023.
Primary outcome assessed was poor functional outcome, defined as mRS score of 3–6 at 90 days.
Utilized multivariable logistic regression and restricted cubic spline analysis to investigate associations.
Included 486 patients with a median NLR of 5.51.
Performed subgroup analyses across various demographics and health conditions.
67.28% of patients experienced poor functional outcomes, correlating with higher NLR values.
Median NLR was significantly higher in patients with poor outcomes (5.97 vs 4.71; P < 0.001).
Each unit increase in NLR was linked to an independent increase in risk for poor outcomes (aOR: 1.15; P < 0.001).
Patients in the highest NLR tertile had a substantially increased risk of poor outcomes (aOR: 2.64; P for trend < 0.001).
The optimal NLR cutoff for predicting outcomes was 5.53, with an AUC of 0.649.

Abstract

Systemic inflammation plays a critical role in secondary brain injury following acute ischemic stroke. The neutrophil-to-lymphocyte ratio (NLR) has emerged as a readily accessible inflammatory biomarker; however, its prognostic value in large vessel occlusion (LVO) stroke patients undergoing endovascular thrombectomy (EVT) remains incompletely characterized. This study aimed to investigate the association between admission NLR and 90-day functional outcomes in LVO stroke patients treated with EVT. We conducted a retrospective cohort study of consecutive LVO stroke patients who underwent EVT at a comprehensive stroke center between January 2019 and December 2023. The primary outcome was poor functional outcome, defined as modified Rankin Scale (mRS) score of 3–6 at 90 days. Multivariable logistic regression, restricted cubic spline analysis, and subgroup analyses were performed to evaluate the association between NLR and outcomes. A total of 486 patients were included (mean age 66.75 ± 13.18 years; 50.82% female). The median NLR was 5.51 (interquartile range IQR: 3.98–8.26). Poor functional outcome occurred in 327 patients (67.28%). Patients with poor outcomes demonstrated significantly higher NLR compared to those with favorable outcomes (median 5.97 vs. 4.71; P < 0.001). After multivariable adjustment, each unit increase in NLR was independently associated with poor functional outcome (adjusted odds ratio aOR: 1.15; 95% confidence interval CI: 1.08–1.22; P < 0.001). Patients in the highest NLR tertile exhibited substantially elevated risk compared to the lowest tertile (aOR: 2.64; 95% CI: 1.54–4.59; P for trend < 0.001). The optimal NLR cutoff was 5.53, yielding an area under the receiver operating characteristic curve of 0.649 (95% CI: 0.599-0.700). Subgroup analyses demonstrated consistent associations across age, sex, atrial fibrillation status, and diabetes subgroups. Elevated admission NLR is independently associated with poor 90-day functional outcomes in LVO stroke patients undergoing EVT. NLR represents a simple, cost-effective, and readily available biomarker that may facilitate early risk stratification and guide clinical decision-making in this high-risk population.

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