Monocyte-to-Lymphocyte Ratio in Clot Analysis as a Marker of Cardioembolic Stroke Etiology
Por:
Juega, J, Palacio-Garcia, C, Rodriguez, M, Deck, M, Rodriguez-Luna, D, Requena, M, Garcia-Tornel, A, Rodriguez-Villatoro, N, Rubiera, M, Boned, S, Muchada, M, Ribo, M, Pinana, C, Hernandez, D, Coscojuela, P, Diaz, H, Sanjuan, E, Hernandez-Perez, M, Dorado, L, Quesada, H, Cardona, P, De-la-Torre, C, Tomasello, A, Gallur, L, Sanchez, M, Gonzalez-Rubio, S, Camacho, J, Ramon-Y-Cajal, S, Alvarez-Sabin, J, Molina, CA and Pagola, J
Ahead of Print:
1 sep 2021
Resumen:
The aim of the study was to find markers of high-risk cardioembolic etiology (HRCE) in patients with cryptogenic strokes (CS) through the analysis of intracranial clot by flow cytometry (FC). A prospective single-center study was designed including patients with large vessel occlusion strokes. The percentage of granulocytes, monocytes, lymphocytes, and monocyte-to-lymphocyte ratio (MLr) were analyzed in clots extracted after endovascular treatment (EVT) and in peripheral blood. Large arterial atherosclerosis (LAA) strokes and high-risk cardioembolic (HRCE) strokes were matched by demographics and acute reperfusion treatment data to obtain FC predictors for HRCE. Multilevel decision tree with boosting random forest classifiers was performed with each feature importance for HRCE diagnosis among CS. We tested the validity of the best FC predictor in a cohort of CS that underwent extensive diagnostic workup. Among 211 patients, 178 cases underwent per-protocol workup. The percentage of monocytes (OR 1.06, 95% CI 1.01-1.11) and MLr (OR 1.83, 95% CI 1.12-2.98) independently predicted HRCE diagnosis when LAA clots (n = 28) were matched with HRCE clots (n = 28). Among CS (n = 82), MLr was the feature with the highest weighted importance in the multilevel decision tree as a predictor for HRCE. MLr cutoff point of 1.59 yield sensitivity of 91.23%, specificity of 44%, positive predictive value of 78.79%, and negative predictive value of 68.75 for HRCE diagnosis among CS. MLr >= 1.6 in clot analysis predicted HRCE diagnosis (OR, 6.63, 95% CI 1.85-23.71) in a multivariate model adjusted for age. Clot analysis by FC revealed high levels of monocyte-to-lymphocyte ratio as an independent marker of cardioembolic etiology in cryptogenic strokes.
Filiaciones:
Juega, J:
Autonomous Univ Barcelona, Vall dHebron Univ Hosp, Vall dHebron Res Inst, Dept Neurol,Med Dept,Stroke Unit, Passeig Vall dHebron 119-129, Barcelona 08035, Spain
Palacio-Garcia, C:
Vall dHebron Univ Hosp, Hematol Dept, Vall dHebron Hosp Campus, Barcelona, Spain
Rodriguez, M:
Autonomous Univ Barcelona, Vall dHebron Univ Hosp, Vall dHebron Res Inst, Dept Neurol,Med Dept,Stroke Unit, Passeig Vall dHebron 119-129, Barcelona 08035, Spain
Deck, M:
Autonomous Univ Barcelona, Vall dHebron Univ Hosp, Vall dHebron Res Inst, Dept Neurol,Med Dept,Stroke Unit, Passeig Vall dHebron 119-129, Barcelona 08035, Spain
Rodriguez-Luna, D:
Autonomous Univ Barcelona, Vall dHebron Univ Hosp, Vall dHebron Res Inst, Dept Neurol,Med Dept,Stroke Unit, Passeig Vall dHebron 119-129, Barcelona 08035, Spain
Requena, M:
Autonomous Univ Barcelona, Vall dHebron Univ Hosp, Vall dHebron Res Inst, Dept Neurol,Med Dept,Stroke Unit, Passeig Vall dHebron 119-129, Barcelona 08035, Spain
Garcia-Tornel, A:
Autonomous Univ Barcelona, Vall dHebron Univ Hosp, Vall dHebron Res Inst, Dept Neurol,Med Dept,Stroke Unit, Passeig Vall dHebron 119-129, Barcelona 08035, Spain
Rodriguez-Villatoro, N:
Autonomous Univ Barcelona, Vall dHebron Univ Hosp, Vall dHebron Res Inst, Dept Neurol,Med Dept,Stroke Unit, Passeig Vall dHebron 119-129, Barcelona 08035, Spain
Rubiera, M:
Autonomous Univ Barcelona, Vall dHebron Univ Hosp, Vall dHebron Res Inst, Dept Neurol,Med Dept,Stroke Unit, Passeig Vall dHebron 119-129, Barcelona 08035, Spain
Boned, S:
Autonomous Univ Barcelona, Vall dHebron Univ Hosp, Vall dHebron Res Inst, Dept Neurol,Med Dept,Stroke Unit, Passeig Vall dHebron 119-129, Barcelona 08035, Spain
Muchada, M:
Autonomous Univ Barcelona, Vall dHebron Univ Hosp, Vall dHebron Res Inst, Dept Neurol,Med Dept,Stroke Unit, Passeig Vall dHebron 119-129, Barcelona 08035, Spain
Ribo, M:
Autonomous Univ Barcelona, Vall dHebron Univ Hosp, Vall dHebron Res Inst, Dept Neurol,Med Dept,Stroke Unit, Passeig Vall dHebron 119-129, Barcelona 08035, Spain
Pinana, C:
Vall dHebron Univ Hosp, Dept Neuroradiol, Barcelona, Spain
Hernandez, D:
Vall dHebron Univ Hosp, Dept Neuroradiol, Barcelona, Spain
Coscojuela, P:
Vall dHebron Univ Hosp, Dept Neuroradiol, Barcelona, Spain
Diaz, H:
Vall dHebron Univ Hosp, Dept Neuroradiol, Barcelona, Spain
Sanjuan, E:
Autonomous Univ Barcelona, Vall dHebron Univ Hosp, Vall dHebron Res Inst, Dept Neurol,Med Dept,Stroke Unit, Passeig Vall dHebron 119-129, Barcelona 08035, Spain
:
Germans Trias I Pujol Univ Hosp, Dept Neurol, Stroke Unit, Badalona, Spain
:
Germans Trias I Pujol Univ Hosp, Dept Neurol, Stroke Unit, Badalona, Spain
Quesada, H:
Bellvitge Univ Hosp, Stroke Unit, Dept Neurol, Lhospitalet De Llobregat, Spain
Cardona, P:
Bellvitge Univ Hosp, Stroke Unit, Dept Neurol, Lhospitalet De Llobregat, Spain
De-la-Torre, C:
Bellvitge Univ Hosp, Stroke Unit, Dept Neurol, Lhospitalet De Llobregat, Spain
Tomasello, A:
Vall dHebron Univ Hosp, Dept Neuroradiol, Barcelona, Spain
Gallur, L:
Vall dHebron Univ Hosp, Hematol Dept, Vall dHebron Hosp Campus, Barcelona, Spain
Sanchez, M:
Vall dHebron Univ Hosp, Hematol Dept, Vall dHebron Hosp Campus, Barcelona, Spain
Gonzalez-Rubio, S:
Vall dHebron Univ Hosp, Hematol Dept, Vall dHebron Hosp Campus, Barcelona, Spain
Camacho, J:
Vall dHebron Univ Hosp, Dept Pathol, Barcelona, Spain
Ramon-Y-Cajal, S:
Vall dHebron Univ Hosp, Dept Pathol, Barcelona, Spain
Alvarez-Sabin, J:
Autonomous Univ Barcelona, Vall dHebron Univ Hosp, Vall dHebron Res Inst, Dept Neurol,Med Dept,Stroke Unit, Passeig Vall dHebron 119-129, Barcelona 08035, Spain
Molina, CA:
Autonomous Univ Barcelona, Vall dHebron Univ Hosp, Vall dHebron Res Inst, Dept Neurol,Med Dept,Stroke Unit, Passeig Vall dHebron 119-129, Barcelona 08035, Spain
Pagola, J:
Autonomous Univ Barcelona, Vall dHebron Univ Hosp, Vall dHebron Res Inst, Dept Neurol,Med Dept,Stroke Unit, Passeig Vall dHebron 119-129, Barcelona 08035, Spain
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