NLR–FAR Index as a superior predictor of 30-day functional outcome after endovascular thrombectomy in acute ischemic stroke

TL;DR

This study shows that a new blood-based index, combining two inflammation markers, can predict recovery after stroke treatment better than either marker alone.

Contribution

The novel NLR–FAR Index is introduced as a superior predictor of post-stroke outcomes compared to individual biomarkers.

Findings

The NLR–FAR Index strongly predicts poor 30-day outcomes after stroke treatment.

The index outperforms NLR and FAR individually in predicting functional recovery.

A threshold of 0.62 in the NLR–FAR Index marks increased risk of adverse outcomes.

Abstract

To determine whether the neutrophil-to-lymphocyte ratio–fibrinogen-to-albumin ratio (NLR–FAR) Index predicts long-term prognosis in acute ischemic stroke patients undergoing endovascular thrombectomy (EVT).

Systemic inflammatory imbalance contributes to ischemic brain injury, but the combined effect of NLR and FAR on EVT outcomes has remained unclear.

We retrospectively analyzed patients treated with EVT. A composite inflammatory-coagulation index, designated as the NLR–FAR Index, was defined as the product of NLR and FAR. The primary endpoint was 30-day functional outcome defined by the modified Rankin Scale (mRS), with poor outcome as mRS ≥3. Logistic regression and restricted cubic spline analyses were used to assess associations.

Of 254 patients, 121 (47.6%) had poor outcomes. Higher NLR, FAR, and especially NLR–FAR Index were significantly associated with poor prognosis. The NLR–FAR Index showed the strongest predictive effect (adjusted OR = 1.910, 95% CI: 1.079–3.384). Restrictive cubic spline analysis shows that when the NLR-FAR index exceeds the threshold of 0.62, the risk of adverse outcomes at 30 days begins to significantly increase.

The NLR–FAR Index independently predicts functional outcomes after EVT and outperforms NLR or FAR alone. This accessible biomarker may aid early risk stratification and individualized management in acute ischemic stroke.

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