Segmented neutrophil-to-monocyte ratio and systemic immune-inflammation index associated with the severity and functional prognosis of acute ischemic stroke.

PURPOSE/AIM OF THE STUDY: To identify the inflammation indexes associated with the severity and functional prognosis in ischemic stroke. MATERIAL AND METHODS: A prospective study was conducted with ischemic stroke cases included in the i-ReNe clinical registry. Patients were divided into groups according to the severity on admission measured by the National Institutes of Health Stroke Scale (NIHSS) and the functional prognosis at 30 and 90 days of discharge measured by the modified Rankin Scale (mRS). RESULTS: We included 145 patients with a mean age of 61.5 ± 12.75, 97 (66.9%) were men. The leukocyte and neutrophil counts, Neutrophil-to-Lymphocyte ratio (NLR), Derived Neutrophil-to-Lymphocyte ratio (dNLR), Platelet-to-Lymphocyte ratio (PLR), Segmented Neutrophil-to-Monocyte ratio (SeMo ratio), and Systemic Immune-inflammation index (SII) were higher in moderate-to-severe stroke (NIHSS ≥6). NLR, PLR, SeMo ratio, and SII were higher in the group with severe disability and death at 30 days (mRS ≥4). In the multiple logistic regression analyses, SeMo ratio >14.966 and SII >623.723 were associated with moderate-to-severe stroke (NIHSS ≥6). In addition, SeMo ratio >7.845 was associated with severe disability and death at 30 days (mRS ≥4). CONCLUSIONS: Systemic inflammation indexes could be rapid and low-cost markers used in the initial evaluation of ischemic stroke, whose values could help to stratify patients according to their severity and functional prognosis. This is the first study to establish a relationship between ischemic stroke and the SeMo ratio.

Contribution of Onset-to-Alarm Time to Prehospital Delay in Patients with Ischemic Stroke.

BACKGROUND: Stroke is a leading cause of death and disability. Tissue plasminogen activator (tPA) improves the clinical outcome when administered properly; however, the most important factor to receive tPA is time. The main reason for late hospital arrival is a considerable delay in onset-to-alarm time (OAT), comprising more than 50% of the onset-to-door time. AIMS: To identify the factors associated with a delay in OAT and evaluate its contribution to onset-to-door time in ischemic stroke patients. METHODS: Prospective cohort of stroke patients admitted to the UANL University Hospital. OAT was defined as the time from identification of stroke symptoms to the decision to seek medical attention. RESULTS: A total of 189 patients were included. Mean age was 61 ± 13 years, 62% were men. One-hundred and one patients had a short OAT, but only 20.9% arrived during the first 3 hours after stroke onset. Being employed (P = 0032; odds ratio [OR] 2.784, 95% confidence interval [CI] 1.091-7.104), attributing symptoms to stroke (P = 0016; OR 3.348, 95% CI 1.254-8.936), and perceiving stroke symptoms as severe (P = 0031;OR 2.428, 95% CI 1.083-5.445) were associated with a shorter OAT. CONCLUSIONS: OAT consumes a considerable amount of the onset-to-door time. It is necessary to increase stroke knowledge and emphasize the severity of stroke, regardless of the severity of its clinical manifestations to reduce the prehospital delay, especially in countries with limited access to treatment with an extended time frame.