Comparative the predictive value of neutrophil-to-HDL ratio and monocyte-to-HDL ratio for early neurological deterioration in acute ischemic stroke patients following intravenous thrombolysis.

BACKGROUND

Numerous studies have indicated that the neutrophil-to-high-density lipoprotein cholesterol ratio (NHR) and the monocyte-to-high-density lipoprotein cholesterol ratio (MHR) are reliable indicators of adverse cardiovascular outcomes in patients with coronary artery disease and ischemic stroke. However, their association with early neurological deterioration (END) following intravenous thrombolytic therapy (IVT) in acute ischemic stroke (AIS) patients remains unexplored. The primary objective of this study was to investigate the relationship between NHR and MHR and the risk of END after IVT.

METHODS

This study enrolled 433 stroke patients who underwent IVT. The NHR and MHR were calculated from routine blood tests obtained at emergency admission. END was defined as an increase in the National Institutes of Health Stroke Scale (NIHSS) score of ≥ 4 points within 24 h post-IVT, while a modified Rankin Scale (mRS) score > 2 at 90 days indicated a poor functional outcome. Differences in clinical indicators between the END and non-END groups were compared, and risk factors for END were identified using multivariate logistic regression analysis.

RESULTS

The NIHSS score, the rate of proximal artery occlusion, fasting glucose, the NHR, and the MHR were significantly higher in the END group compared to the non-END group. Multifactorial logistic regression analysis revealed that both the NHR (odds ratio 1.257; 95% CI: 1.107–1.427, P < 0.001) and the MHR (odds ratio 12.510; 95% CI: 3.144–49.781, P < 0.001) were significant risk factors for END, although they did not show a statistically significant association with poor functional outcomes. The areas under the receiver (AUCs) operating characteristic (ROC) curve for predicting END were 0.640 (95% CI: 0.562–0.719, P = 0.001) for NHR and 0.584 (95% CI: 0.512–0.657, P = 0.048) for MHR. Additionally, the optimal cutoff value for NHR was determined to be 1.848 × 109/mmol.

CONCLUSION

Both NHR and MHR demonstrate strong predictive value for END, with NHR potentially serving as a superior predictor compared to MHR in AIS patients receiving IVT.