Impact Of Platelet To Lymphocyte Ratio (PLR) And Its Association With The National Institute Of Health Stroke Scale (NIHSS) On Prediction Of Severity In Patients Of Acute Ischemic Stroke.

Abstract

Introduction and Background   : The abrupt onset of a localized neurological loss due to a vascular etiology is a hallmark of a cerebrovascular accident or stroke. Platelets help in the process of thromboemboli formation . When endothelial cell damage (plaque rupture) occurs, activated platelets clump together, contributing to the development of thrombotic lesions. However, during the course of atherosclerosis, lymphocytes have an anti-inflammatory impact. Studies show that measuring the inflammatory response can be done quickly and easily using the platelet-to-lymphocyte ratio (PLR). PLR levels beyond a particular threshold enhance the risk of a worse result and a larger infarct in stroke patients . A novel, inexpensive biomarker of the systemic inflammatory response that is impacted by changes in platelets and lymphocytes after an acute stroke is the platelet-to-lymphocyte ratio (PLR). Thus, the goal of the current study was to determine the significance of PLR (Platelet to Lymphocyte Ratio) in acute ischemic stroke patients and how it relates to NIHSS in terms of prediction of stroke severity.

Materials and Methods : This was a cross-sectional study conducted at a tertiary care center  in Chengalpattu, Tamil Nadu. Inpatients of the center who were diagnosed with acute ischemic stroke by NCCT (non-contrast computed tomography) brain from January 2023 to January 2024 were included in the study.  The records of inpatients  who were diagnosed with acute ischemic stroke from January 2023 to January 2024 were collected. NIHSS score at admission was documented along with their comorbidities, risk factors, and complete blood counts.The correlation between PLR and NIHSS was analysed.

Results : A total of 100 cases were studied. The mean age was 62.98 ± 10.10 years, with ages ranging from 42 years to 90 years. The majority of cases fell within the 61-70 age group.Blood parameter analysis revealed  platelet to lymphocyte ratio (PLR) at 191.11 ± 125.83, the mean NIHSS score was 10.1 ± 6.07.  Notably, a strong positive correlation (Spearman's rho = 0.837, p < 0.00001) was found between PLR and NIHSS scores, indicating that higher PLR is associated with more severe neurological impairments.

Conclusion: Platelet lymphocyte ratio can be used as an inexpensive and easily available marker for the assessment of the severity of acute ischemic stroke as shown by its linearly positive correlation with the NIHSS score and its elevated value in acute ischemic stroke patients.