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Objective:To investigate the correlation between malnutrition and early neurological deterioration (END) after intravenous thrombolysis in patients with acute ischemic stroke.Methods:Patients with ischemic stroke received intravenous thrombolysis in the Department of Neurology, Nanjing Jiangbei People's Hospital from January 2018 to December 2021 were retrospectively enrolled. Nutritional status was assessed by geriatric nutritional risk index (GNRI) and prognostic nutritional index (PNI). END was defined as an increase of ≥4 in the National Institutes of Health Stroke Scale score within 24 h after intravenous thrombolysis compared with the baseline value. The demographic and baseline clinical data of the patients in the END group and the non-END group were compared. Multivariate logistic regression analysis was used to determine the independent correlation between malnutrition and END. Results:A total of 256 patients were enrolled, including 156 males (60.9%), aged 65.6±12.0 years. According to GNRI and PNI, there were 122 (46.7%) and 62 (24.2%) patients with malnutrition respectively. END occurred in 37 patients (14.5%) during hospitalization. Multivariate logistic regression analysis showed that after adjusting for other confounding factors, there was a significant independent correlation between malnutrition and END after intravenous thrombolysis in patients with acute ischemic stroke (severe malnutrition as assessed by GNRI compared to normal nutritional status: odds ratio 5.736, 95% confidence interval 1.033-31.866, P=0.046; severe malnutrition as assessed by PNI compared to normal nutritional status: odds ratio 4.928, 95% confidence interval 1.589-15.282, P=0.006). Conclusion:Malnutrition is very common in patients with acute ischemic stroke and has a significant correlation with END after intravenous thrombolysis.
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Objective:To investigate the relationship between plasma Dickkopf-1 and early neurological deterioration (END) and outcome in patients with acute ischemic stroke.Methods:From January 2020 to December 2020, consecutive patients with first-ever ischemic stroke form the Department of Neurology, Nanjing Jiangbei Hospital were included. All patients were hospitalized within 24 h after onset. END was defined as the National Institutes of Health Stroke Scale (NIHSS) score within 7 d after admission increased by ≥2 or motor function score increased by ≥1 compared with the baseline. Poor outcome was defined as the modified Rankin Scale score >2 at 90 d after onset. Multivariate logistic regression analysis was used to determine the independent correlation between plasma Dickkopf-1 and END and outcome. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of plasma Dickkopf-1 for END and poor outcome. Results:A total of 176 patients were enrolled, including 92 males (52.3%), aged 66.7±9.6 years. The median Dickkopf-1 was 4.30 μg/L, 52 patients (29.5%) developed END, and 81 (46.0%) had poor outcome. Multivariate logistic regression analysis showed that the higher Dickkopf-1 was an independent predictor of END (odds ratio [ OR] 1.696, 95% confidence interval [ CI] 1.223-2.351; P=0.002) and poor outcome ( OR 1.566, 95% CI 1.156-2.121; P=0.004). ROC curve analysis showed that plasma Dickkopf-1 had good predictive value for END, and its area under the curve was 0.717 (95% CI 0.634-0.801); the optimal cut-off value was 4.40 μg/L, and the corresponding predictive sensitivity and specificity were 71.2% and 60.5%, respectively. Dickkopf-1 also had good predictive value for poor outcome, and its area under the curve was 0.701 (95% CI 0.624-0.778); the optimal cut-off value was 4.25 μg/L, and the corresponding predictive sensitivity and specificity were 65.4% and 61.1%, respectively. Conclusion:Plasma Dickkopf-1 has good predictive value for END and poor outcome in patients with acute ischemic stroke.
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Objective:To investigate the predictive value of thromboelastographic (TEG) parameters for early neurological deterioration (END) after intravenous thrombolysis in patients with acute ischemic stroke.Methods:Consecutive patients with acute ischemic stroke treated with intravenous thrombolysis in Nanjing Jiangbei People's Hospital between January 2017 and December 2019 were enrolled. They completed TEG examination within 24 h after admission. END was defined as an increase of 4 points or more from the baseline National Institutes of Health Stroke Scale (NIHSS) score within 24 h after admission. Univariate analysis was used to compare the demographic characteristics, baseline data, laboratory indicators and TEG parameters between the END group and the non-END group. Multivariate logistic regression analysis was used to determine the independent risk factors for END. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of different models for END. Results:A total of 174 patients with acute ischemic stroke were enrolled, aged (68.9±13.4) years, 111 (63.8%) were male, median baseline NIHSS score was 5.0, and 29 (16.7%) had END. Compared with the patients in the non-END group, the age, homocysteine, fasting blood glucose, high-sensitivity C-reactive protein (hs-CRP), baseline NIHSS score and the proportion of patients with diabetes mellitus and hemorrhagic transformation (HT) in the END group were significantly increased (all P<0.05), and the coagulation reaction time of TEG was significantly reduced ( P=0.005). Multivariate logistic regression analysis showed that after adjusting for confounding factors, age (odds ratio [ OR] 1.023, 95% confidence interval [ CI] 1.002-1.066; P=0.031), diabetes mellitus ( OR 2.627, 95% CI 1.021-7.176; P=0.041), higher hs-CRP level ( OR 1.050, 95% CI 1.018-1.083; P=0.002), HT ( OR 3.088, 95% CI 1.707-13.492; P=0.034) and TEG coagulation reaction time reduction ( OR 0.440, 95% CI 0.213-0.907; P=0.026) were the independent risk factors for END in patients with acute ischemic stroke receiving intravenous thrombolysis. ROC analysis showed that the area under the curve of the basic model composed of age, diabetes, hs-CRP level, and HT for predicting END was 0.766 (95% CI 0.665-0.871). When TEG coagulation reaction time was added to the basic model, the area under ROC curve for predicting END was increased to 0.816 (95% CI 0.733-0.899). Conclusion:The TEG coagulation reaction time reduction has a certain predictive value for END in patients with acute ischemic stroke receiving intravenous thrombolytic therapy.
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Objective To investigate the correlations of P2Y12 gene polymorphisms with clopidogrel resistance and long-term outcome in patients with acute ischemic stroke. Methods From June 2015 to June 2017, consecutive patients with acute ischemic stroke admitted to the Department of Neurology, Nanjing Jiangbei People's Hospital were enrolled. Thromboelastography was used to measure platelet inhibition rate and assess clopidogrel resistance. Polymerase chain reaction was used to assay C34T and G52T polymorphisms of P2Y12 gene. The patients were followed up at 12 months after discharge. The primary outcome was combined outcome of stroke recurrence, myocardial infarction, and death due to cardiocerebrovascular events. Results A total of 214 patients were enrolled, 51 (23.8%) had clopidogrel re-sistance and 29 (13.4%) had major outcome events. One hundred twenty-eight (59.8%) patients were C34T CC genotype and 86 (40.2%) were CT+TT genotype. The proportion of clopidogrel resistance in patients with CT+TT genotype was significantly higher than that with CC genotype ( 76.5% vs.28.8%;χ2=25.672, P=0.001). There were 131 patients (61.2%) with G52T GG genotype and 83 (38.8%) with GT+TT genotype. There was no significant difference in the proportion of clopidogrel resistance between the GT+TT genotype and the GG genotype (43.1% vs.37.4%; χ2=0.534, P=0.465). Multiple logistic regression analysis indicated that age (odds ratio [OR] 1.064, 95%confidence interval [CI] 1.009-1.115;P=0.021), diabetes ( OR 3.773, 95%CI 1.672-8.475; P=0.004), and C34T CT+TT genotype ( OR 9.087, 95%CI 4.416-22.665; P=0.002) were the independent risk factors fot clopidogrel resistance. Cox proportional hazards model analysis showed that age (Hazard ratio [HR] 1.058, 95%CI 1.001-1.121; P=0.049), hypertension ( HR 3.105, 95%CI 1.149-9.523; P=0.028), homocysteine ( HR 1.101, 95%CI 1.020-1.190; P=0.014), and C34T CT+TT genotype ( HR 2.588, 95%CI 1.121-5.967; P=0.026) were independent risk factors for the composite outcome. Conclusion C34T polymorphism of P2Y12 gene in patients with acute ischemic stroke may be a risk factor for clopidogrel resistance and is independently associated with the risk of long-term recurrence of vascular events.
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Objective To investigate the epidemiology characteristics of crawfish related rhabdomyolysis (RM) in Nanjing, 2016.Methods Outpatient and inpatient electronic medical system of 21 hospitals in Nanjing during 2016 were retrospectively searched, and all the patients diagnosed with RM were selected. The patients with none crayfish-related RM was excluded. The epidemiology characteristics were depicted. The geographic information system (GIS) was used to collect, manage and analyze the spatial data, to visualize it, to analyze the spatial distribution features of the disease, and to explore the cause of disease prediction. GeoDa 1.8 software was used to analyze the global and local spatial auto-correlation.Results A total of 1183 patients with crawfish related RM were initially screened, excluding 59 patients with RM caused by trauma, severe exercise, heat stroke, myositis, poisoning, drugs, and genetic diseases, and 1124 patients were enrolled. The proportion of men was 36.48% (410/1124) with an incidence of 12.54/100 thousands; while of women was 63.52% (714/1124) with an incidence of 21.86/100 thousands. The median age at onset was 34 (28, 43) years. From July to August, the incidence of crawfish related RM was the highest, accounting for 96.53% of the total number of cases. The top four incidence areas were Pukou (41.54/100 thousands), Jianye (25.94/100 thousands), Qixia (25.73/100 thousands), Gulou (25.04/100 thousands), all of which were adjacent to the Yangtze River. Global spatial autocorrelation analysis showed: MoranI = 0.427,Z = 2.646,P = 0.003, suggesting that the crawfish related RM had positive spatial autocorrelation. The results showed that the spatial structure of crawfish related RM existed in Nanjing in 2016. Local spatial autocorrelation analysis showed that the high-high concentration areas were Pukou, Jianye and Liuhe. The incidences of above three areas which were the Nanjing section of the lower reaches of the Yangtze River flowed through the region and surrounding areas were higher than the overall incidence of Nanjing.Conclusion The prevalence of crawfish related RM in Nanjing during 2016 had an obvious region-concentrated character and global spatial autocorrelation with the high prevalent regions mainly concentrated in the urban areas adjacent to the Yangtze River.