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The neutrophil–lymphocyte ratio (NLR) is emerging as a biomarker in patients with a myriad of medical conditions. NLR has been confirmed as a potential short-term prognostic indicator for patients with COVID-19.
Neutrophil-to-lymphocyte ratio predicts critical illness patients with 2019 coronavirus disease in the early stage and has been established as a predictor of disease progression and critical deterioration in COVID 19 [Jingyuan Liu]. We sought to describe the role of NLR in predicting poor outcome in patients COVID-19 patients undergoing mechanical thrombectomy  subset of consecutive COVID-19 patients with  acute ischemic stroke.

We evaluated COVID-19 patients with LVO Strokes enrolled into an international 12 center retrospective study of laboratory-confirmed COVID-19 consecutively admitted between March 1st and May 1st in 12. Admission WBC differentials (NLR) were analyzed using a cutoff of ≥ 7.2. Logistic regression models were generated. 

Out of a total of 6698 patients admitted with COVID-19 positive in 12 stroke centers during the study period, the incidence of large vessel occlusion stroke was 38/6698 (0.8%).   An elevated NLR and low TICI grade (TICI1 or TICI2a) are synergistically predictive of worse outcome (LR 11.65 p=0.0030). Patients with an NLR >7.2 were 6.8 times more likely to die (OR 6.8, CI95% 1.2-38.6, p=0.03) and almost 6 times more likely to have a poor outcome (OR 5.9, CI95% 1.3-27.3 , p=0.02). Patients with an NLR > 7.2 were almost 8 times more likely to require prolonged invasive mechanical ventilation (OR 7.8, CI95% 1.2-52.4, p=0.03).

An elevated NLR in the setting of COVID 19 patients with LVO strokes portends significantly worse outcomes and increased mortality regardless of TICI score indicating that the neuroinflammatory response in COVID-19 outweighs any potential benefit of a successful thrombectomy.