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Objective:To investigate the correlation between stress hyperglycemia ratio (SHR) and poor outcome of successful recanalization after endovascular treatment in patients with acute ischemic stroke.Methods:From January 2019 to October 2022, patients with acute ischemic stroke received endovascular treatment and successful recanalization in the Second People’s Hospital of Lianyungang were included retrospectively. SHR was defined as the fasting blood sugar and glycosylated hemoglobin ratio. At 90 d after procedure, the outcome of patients was evaluated using the modified Rankin Scale score. 0-3 was defined as good outcome, and >3 was defined as poor outcome. Multivariate logistic regression analysis was used to determine the independent risk factor for poor outcome. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of SHR for 90 d poor outcome in patients with successful recanalization after endovascular treatment.Results:A total of 159 patients were enrolled, including 98 males (61.6%), aged 69.8±8.9 years old. The baseline National Institutes of Health Stroke Scale (NIHSS) score was 12.6±4.3, and SHR was 1.17±0.46. One hundred and five patients (66.0%) had good outcome, while 54 (34.0%) had poor outcome. There were statistically significant differences in SHR, fasting blood glucose, glycosylated hemoglobin, baseline NIHSS score and the proportion of patients with poor collateral circulation and symptomatic intracranial hemorrhage between the poor outcome group and the good outcome group (all P<0.05). Multivariate logistic regression analysis showed that SHR was an independent predictor of poor outcome (odds ratio 2.254, 95% confidence interval 1.136-4.278; P<0.001). The ROC curve analysis showed that the area under the curve of SHR for predicting poor outcome was 0.726 (95% confidence interval 0.648-0.804; P<0.001), which was higher than fasting blood glucose and glycosylated hemoglobin. The optimal cutoff value for SHR was 1.21, and the sensitivity and specificity for predicting poor outcomes were 66.23% and 75.82%, respectively. Conclusion:SHR is associated with the poor outcome of successful recanalization after endovascular treatment in patients with acute ischemic stroke and can be used as a potential predictor.
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Objective To investigate the predictive value of neutrophil to lymphocyte ratio (NLR) on admission for early neurological deterioration (END) in patients with lacunar stroke.Methods Patients with acute lacunar stroke admitted to the Department of Neurology,the Second People's Hospital of Lianyungang from June 2015 to October 2017 were enrolled retrospectively.END was defined as an increase of ≥2 in the National Institutes of Health Stroke Scale (NIHSS) score within 72 h of admission.Multivariate logistic regression analysis was used to determine the independent risk factors for END.The receiver operating characteristic (ROC) curve was used to analyze the predictive value of NLR for END in patients with lacunar stroke.Results A total of 309 patients with acute lacunar infarction were enrolled,including 180 males (58.2％),aged 59.7 ±7.3 years;65 patients (21.0％) in END group and 244 (79.0％) in non-END group.Multivariate logistic regression analysis showed that after adjusting for other confounders,NLR was an independent risk factor for END in lacunar stroke (odds ratio 4.508,95％ confidence interval 3.128-7.547;P＜0.001).ROC curve analysis showed that the area under the curve of NLR predicting END in patients with lacunar stroke was 0.725 (95％ confidence interval 0.671-0.776;P ＜ 0.001);the optimal cut-off value was 2.32,the sensitivity of predicting END was 61.21％,and the specificity was 72.54％.Conclusion The elevated NLR after admission is an independent risk factor for END in patients with lacunar stroke,which has certain value for early identification and prediction of END.
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Objective To study the predictive value of lipoprotein-associated phospholipase A2 ( Lp-PLA2)for early neurological deterioration (END) in patients with lacunar infarction. Methods Between January 2016 and July 2018,281 consecutive patients with first-ever acute lacunar infarction admitted to the Department of Neurology, the Second People's Hospital of Lianyungang were enrolled retrospectively. They were divided into END group (n = 75 ) and non-END group ( n = 206) depending on whether END occurred or not. The general data ( age, sex, body mass index,past medical history) ,clinical data (National Institute of Health stroke scale [ NIHSS score] ) , onset to admission time,imaging data (white matter lesion score,cerebral microhemorrhage score and branch atherosclerosis) , treatment methods and laboratory findings such as neutrophil to lymphocyte ratio, total cholesterol,low- density lipoprotein cholesterol, fasting blood glucose, hypersensitive C-reactive protein, homocysteine, and Lp-PLA2 were compared in patients between the two groups. Immunoturbidimetry was used to determine the level of Lp-PLA2 in blood. SPSS 22. 0 software was used to analyze and process the data. Multivariate logistic regression was used to analyze the risk factors for affecting the occurrence of END in patients with lacunar cerebral infarction. Receiver operating characteristic (ROC) curve was used to analyze the value of Lp-PLA2 in predicting the occurrence of END in lacunar infarction. Results Univariate analysis showed that NLR (2. 5 ± 0. 5 vs. 2. 3 ± 0. 5, t = 2. 996) , low-density lipoprotein cholesterol (2. 6 ± 0. 8 mmol/L vs. 2. 3 ± 0. 7 mmol/L, t = 3. 056), NIHSS score on admission ( 3.4 ± 1.5 vs. 3.0 ± 1.4, l = 2. 080), and the proportion of patients with branch atherosclerosis (21. 3% [ 16/75] vs. 7. 3% [ 15/206] #=1 1-061) in the END group were higher than those in the non-END group (240 ± 26 jxg/L vs. 180 ±23 p,g/L, I = 9. 032) ,and the difference was statistically significant (all P <0. 05). Multivariate logistic regression analysis showed that the increased level of NLR (0/,3.927,95% CI 2.918 -5.016,P = 0.020),Lp-PLA2 (OR, 1.026,95% 67 1.019-1.034, P <0.01), low-density lipoprotein cholesterol (OR, 2.715,95% CI 2.193 -3.273, P =0.025) , NIHSS score on admission (OR,2. 831 ,95% CI 2.412 -3. 197, P = 0.028) , and branch atherosclerosis ( OR,4. 552 ,95% CI 2. 934 -7. 017 , P = 0. 002) were the independent risk factors for lacunar infarction occurring END. Receiver operating characteristic ( ROC) curve analysis showed that the area under the curve of Lp-PLA2 predicting END was 0. 799 (95% CI 0. 728 -0. 833 ,P< 0. 01 ) ;the optimal cut-off value was 189 jtg/L, the sensitivity for predicting END was 92. 3% ,and the specificity was 55. 4%. Conclusion The increased level of serum I.p-PLA2 is an independent risk factor for lacunar infarction occurring END,and it has certain predictive value for END.
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Objective To investigate the predictive value of serum lipoprotein-associated phospholipase A2(Lp-PLA2) for the outcomes in patients with large atherosclerotic stroke (LAA). Methods Patients with LAA admitted to the Second People's Hospital of Lianyungang from March 2015 to January 2018 were enrolled retrospectively. The outcomes were evaluated by the modified Rankin Scale at 90 d after onset, 0-2 was defined as good outcome. Multivariate logistic regression analysis was used to identify the independent risk factors for poor outcome. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of Lp-PLA2for outcomes. Results A total of 121 patients with LAA were enrolled, including 64 males (52.9%) and 57 females (47.1%), aged 63.5 ±9.5 years; 72 (59.5%) had good outcome and 49 (40.5%) had poor outcome. The differences were statistically significant in the proportion of diabetic patients (26.4% vs.65.3%; χ2=18.110, P<0.001) and glycated hemoglobin ( 6.39% ±2.33% vs. 7.58% ±3.12%; t=1.663, P=0.041), baseline National Institutes of Health Stroke Scale (NIHSS) score (5 [3-6] vs.10[7 -14]; Z= -7.498, P< 0.001), and Lp-PLA2(194.7 ±84.3 μg/L vs.291.4 ± 82.6 μg/L; t= -5.447, P<0.001) between the good outcome group and the poor outcome group. Multivariate logistic regression analysis showed that diabetes ( odds ratio [ OR] 1.215, 95% confidence interval [CI] 1.102-1.601; P=0.046), glycosylated hemoglobin ( OR 2.275, 95% CI 1.065-4.865; P=0.037), baseline NIHSS score ( OR 2.113, 95% CI 1.585-2.734; P=0.015), and Lp-PLA2(OR 5.183, 95% CI 3.203-8.134; P<0.001) were the independent risk factors for poor outcomes in patients with LAA. ROC analysis showed that the area under the curve of Lp-PLA2predicting poor outcome was 0 .792 (95% CI 0.713-0.872); the optimal cut-off value was 260.5 μg/L, the sensitivity for predicting poor outcome was 79.6%, and the specificity was 84.7%. Conclusion The higher serum Lp-PLA2level is an independent predictive factor for poor outcome in patients with LAA. It has a higher predictive value for poor outcome.