ABSTRACT NUMBER: ESOC2026A998 HIGHER LYMPHOCYTE-TO-MONOCYTE RATIO PREDICTS BETTER 90-DAY FUNCTIONAL OUTCOME AFTER REPERFUSION-TREATED ISCHEMIC STROKE

Abstract Background and aims Acute ischaemic stroke (AIS) is a cause of long-term disability. Despite advances in reperfusion therapies, early prediction of functional recovery is limited. Haematological indices such as neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) are inexpensive markers of systemic inflammation; however, their prognostic role in AIS remains uncertain. Our aim was to evaluate the predictive value of NLR, LMR, and PLR for functional outcome at 90 days in AIS patients treated with reperfusion therapies. Methods We analysed a retrospective cohort of AIS patients treated with mechanical thrombectomy, with or without intravenous thrombolysis. Functional outcome was assessed at 90 days using the modified Rankin Scale (mRS). Haematological inflammatory ratios were modelled as continuous and categorical variables, using ordinal and binary logistic regression models. Multivariable binary models incorporated ROC-derived thresholds and LASSO-based covariate selection. Subgroup analyses examined associations by stroke aetiology, occlusion site, and reperfusion success. Results A total of 320 patients were included (median [IQR] age, 70.5 [59.0–78.0] years; 41.7% female). Higher LMR was independently associated with favourable outcome at 90 days (OR = 0.34, 95% CI: 0.15–0.75; p = 0.009), outperforming NLR and PLR. Categorised LMR improved model performance (mean AUC = 0.89, SD = 0.01). NIHSS at 24 h and baseline glucose remained the strongest clinical predictors. In subgroup analyses, high LMR retained prognostic value in cardioembolic stroke, M1 occlusions, and patients achieving complete reperfusion. Conclusions LMR is a reliable predictor of post-stroke functional outcome. Integrating LMR into risk stratification models may support more personalised post-acute care decisions. Conflict of interest Diana Lucía Tarruella Hernández: nothing to disclose. Antonio García Molina: nothing to disclose. Marta Dolcet Negre: nothing to disclose. Alicia Aliena-Valero: nothing to disclose. Álvaro Lucero Garófano: nothing to disclose. Manuel Pedrero-Prieto: nothing to disclose. Lluis Morales Caba: nothing to disclose. Gerardo Fortea: nothing to disclose. Fernando Aparici: nothing to disclose. Juan Manuel Sanchis Garcia: nothing to disclose. Víctor Vázquez-Añón Pérez: nothing to disclose. María Jesús Rivas López: nothing to disclose. Juan Bautista Salom Sanvalero: nothing to disclose. José Ignacio Tembl: nothing to disclose. Irene Escudero Martínez: nothing to disclose