Predictive value of glycoprotein DKK3 for early neurological deterioration after ischemic stroke

Abstract Objective To explore the value of serum Dickkopf-3 (sDKK3) in predicting Early Neurological Deterioration (END) and in-hospital adverse outcomes in acute ischemic stroke (AIS) patients. Methods AIS patients (n = 200) were included and assessed by the National Institutes of Health Stroke Rating Scale. Serum Dkk3 levels were assessed by ELISA. END was defined as an increase of ≥ 4 points in NIHSS score within 72h. The biological threshold of sDKK3 level and END occurrence were predicted based on X-tile software. Primary outcomes were END and all-cause death, and the secondary outcome was ICU admission during hospitalization. The logistic regression model and Cox risk regression model were applied to evaluate the relationship between DKK3 level and END incidence, all-cause in-hospital mortality, and in-hospital adverse outcomes (ICU admission). Results During hospitalization, the incidence of END in patients with AIS was 13.0 %, and the mortality rate within 7 days after END was 11.54 % (3/26). In patients below the serum DKK3 cutoff (93.0 pg/mL), the incidence of END was 43.5 % (20/48). Patients with lower sDKK3 levels were associated with a 1.188-fold increased risk of developing END (OR = 1.188, 95 % CI 1.055‒1.369, p < 0.0001). However, there was no significant association with admission to the ICU. sDKK3 below the threshold (93.0 pg/mL) was a risk factor for death. Conclusion Predictive threshold levels of serum DKK3 based on X-tile software may be a potential predictive biomarker of in-hospital END in patients with AIS, and low levels of DKK3 are independently associated with increased in-hospital mortality.

Risk factors and their early warning effectiveness for the occurrence of early neurological deterioration in patients with moderate traumatic brain injury / 中华创伤杂志

Objective:To investigate the risk factors and their early warning effectiveness for the occurrence of early neurological deterioration (END) in patients with moderate traumatic brain injury (modTBI).Methods:A retrospective cohort study was conducted to analyze the clinical data of 265 patients with modTBI admitted to the Second Affiliated Hospital of Fuyang Normal University from January 2018 to April 2023. There were 165 males and 100 females, with age range of 20-91 years [(59.5±14.4)years]. The patients were divided into END group ( n=46) (17.4%) and non-END group ( n=219) (82.6%) according to whether the Glasgow Coma Score (GCS) decreased by 2 points or more within 72 hours after injury. Data of the two groups were recorded, including gender, age, basic diseases (hypertension and diabetes), cause of injury (traffic injuries, falls, etc), vomiting before admission, admission GCS, first CT scan time, epilepsy, brain contusion, subarachnoid hemorrhage, types of intracranial hematoma (epidural, subdural, and intracerebral hematoma), types of fracture (skull base fracture and skull fracture), laboratory indicators [platelet count (PLT), blood potassium level, serum total calcium concentration, thrombin time (TT), prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT), level of fibrinogen (FIB), and level of D-dimer. Correlations between above-mentioned indicators and occurrence of END among modTBI patients were assessed and the independent risk factors were revealed by univariate and multivariate binary Logistic regression analysis. Receiver operating characteristic (ROC) curve and area under curve (AUC) were used to evaluate the early-warning effectiveness of each risk factor for END. Results:Univariate analysis showed that admission GCS, first CT scan time, epidural hematoma, subdural hematoma, intracerebral hematoma, serum potassium level, FIB and D-dimer were statistically correlated with occurrence of END among modTBI patients ( P<0.05 or 0.01). Multivariate binary Logistic regression analysis showed that admission GCS≤10 points ( OR=0.53, 95% CI 0.34, 0.84, P<0.01), first CT scan time≤2.0 hours ( OR=0.58, 95% CI 0.37, 0.92, P<0.05), epidural hematoma ( OR=0.26, 95% CI 0.10, 0.69, P<0.05), intracerebral hematoma ( OR=0.14, 95% CI 0.04, 0.44, P<0.01), level of FIB≤2.3 g/L ( OR=0.34, 95% CI 0.18, 0.64, P<0.01), level of D-dimer>10.4 mg/L ( OR=1.04, 95% CI 1.02, 1.07, P<0.01) were independent risk factors for END among modTBI patients. ROC curve analysis showed that the first CT scan time had relatively higher early warning value (AUC=0.79, 95% CI 0.74, 0.84), level of D-dimer (AUC=0.75, 95% CI 0.70, 0.80) and level of FIB (AUC=0.70, 95% CI 0.65, 0.76) had moderate early warning value, which was higher than that of admission GCS (AUC=0.62, 95% CI 0.56, 0.68), intracerebral hematoma (AUC=0.62, 95% CI 0.56, 0.68) and epidural hematoma (AUC=0.60, 95% CI 0.54, 0.66). The combination of the risk factors revealed superior early warning efficiency for END (AUC=0.90, 95% CI 0.85, 0.93). Conclusions:Admission GCS≤10 points, first CT scan time≤2.0 hours, epidural hematoma, intracerebral hematoma, level of FIB≤2.3 g/L and level of D-dimer>10.4 mg/L are independent risk factors for END among modTBI patients. The early warning value of the first CT scan is the highest, followed by D-dimer and FIB, and the early warning effectiveness of admission GCS, intracerebral hematoma and epidural hematoma is ordinary.The combination of the above risk factors has better early warning efficiency for occurrence of END among modTBI patients.

Relationship between platelet-to-lymphocyte ratio and early neurological deterioration in patients with acute ischemic stroke / 中风与神经疾病杂志

@#Objective Platelet-to-lymphocyte ratio(PLR) has been proved to be a new biomarker of inflammation in various diseases. The purpose of this study was to explore the relationship between PLR and early neurological deterioration(END) in patients with acute ischemic stroke(AIS). Methods We retrospectively analyzed the clinical and laboratory data of 1 116 patients with AIS admitted to the Department of Neurology of Shanghai Yangpu District Central Hospital from May 2018 to October 2020.The patients were grouped for analysis according to whether END occurred within 72 hours. They were also grouped by the quartiles of PLR(platelet count divided by lymphocyte count). Univariable and multivariable logistic regression analyses were used to explore independent factors influencing END in patients with AIS. The predictive ability of PLR for the occurrence of END was evaluated by using a receiver operating characteristic(ROC) curve. Results A total of 1 116 patients with AIS were included in the study,with 125 patients(11.2%) in the END group and 991 patients(88.8%) in the non-END group. The univariable analysis showed that PLR in the END group was significantly higher than that in the non-END group(151.68 vs 132.89,P<0.05). The multivariable analysis showed that the risks of END in the PLR Q3 and Q4 groups were 2.172 times[odds ratio(OR)=2.172,95% confidence interval(CI) 1.201-3.929,P=0.01)]and 2.571 times(OR=2.571,95%CI 1.441-4.589,P=0.001) that of the PLR Q1 group. According to the ROC curve,the area under the curve for PLR predicting END was 0.587(95%CI 0.536-0.639,P< 0.001),and the optimal critical value was 119.40,with a sensitivity of 77.6% and a specificity of 39.4%. Conclusion PLR is an independent risk factor for END in patients with AIS. The increase of PLR is associated with a higher risk of END,which demonstrates certain predictive ability of PLR for the occurrence of END.

Clinical research advances in branch atheromatous disease / 中风与神经疾病杂志

@#Branch atheromatous disease(BAD) refers to cerebral infarction that occurs at the opening or bifurcation of the perforating artery and is caused by the stenosis or occlusion of the lumen of the perforating artery due to atherosclerosis. Since BAD was proposed,it has attracted wide attention due to its characteristic imaging manifestations and clinical features of early neurological deterioration. However,since it is unable to visualize the perforating artery on conventional imaging,it is difficult to clarify and unify the diagnostic criteria and therapeutic strategies for BAD. The application of high-resolution magnetic resonance and high-field magnetic resonance can help to display the hemodynamics and luminal plaques of the perforating artery,which will provide assistance for the development of more high-level BAD studies. This article reviews the epidemiology,clinical and imaging manifestations,diagnostic criteria,and treatment of BAD,so as to improve the early identification of this disease among clinicians and provide a reference for the diagnosis and treatment of this diseases.

Relationship between CT angiographic features of intracranial plaques and early neurological deterioration in patients with acute cerebral infarction / 实用放射学杂志

Objective To explore the risk factors of early neurological deterioration(END)in patients with acute cerebral infarction(ACI)based on the characteristics of computed tomography angiography(CTA)images of head and neck plaques.Methods A total of 218 ACI patients were selected,and according to whether END occurred within 72 h after onset,they were divided into an END group(54 cases)and non END group(164 cases).The clinical data and imaging indicators were compared and analyzed between the two groups.Multivariate logistic regression analysis was used to analyze risk factors,and a nomograph prediction model was constructed and evaluated.Results National Institutes of Health Stroke Scale(NIHSS)score at admission ≥4 points,glycated hemoglobin(HbA1c)≥7.7％,severe or above ipsilateral carotid artery stenosis,and unstable plaque(soft plaque and mixed plaque)were the independent risk factors in END patients(P＜0.05).The result of nomograph prediction model showed that its discrimination,accuracy and effectiveness were better.Conclusion NIHSS score at admission,HbA1c level,ipsilateral carotid artery stenosis degree,and plaque type are all independent influencing factors for the occurrence of END.

Correlation study between early neurological deterioration and cerebral microbleeds in patients with acute small artery occlusion / 中国医师进修杂志

Objective:To investigate the relationship between the degree and location of cerebral microbleeds (CMBs) and the early neurological deterioration (END) within 72 h after admissionin in patients with acute small artery occlusive stroke (SAO).Methods:Patients with first-onset SAO hospitalized in Changzhou Second People′s Hospital from July 2020 to January 2021 were retrospectively enrolled. All patients completed the head magnetic resonance imaging including susceptibility weighted imaging. Collected baseline data, and evaluated the National Institutes of Health Stroke Scale (NHISS) scores before admission and within 72 h after onset. Patients were divided into END group and no END group according to whether NIHSS scores increased by ≥3 within 72 h after admission. The baseline characteristics were compared between these two groups. Moreover, the correlation between the degree and location of CMBs and END were analyzed by multivariate Logistic regression.Results:A total of 163 first-episode SAO patients were enrolled. There were 47 patients (28.83%) with END. In END group, there were 35 patients (74.47%) with CMBs which was higher than those in non-END group [42 patients (36.21%)]. In END group, there were 21 patients (44.68%) with severe CMBs, 11 patients (23.41%) with basal ganglia CMBs, 16 patients (34.04%) with mixed CMBs, which were all higher than those in non-END group [5 patients (4.31%) with severe CMBs, 9 patients (7.76%) with basal ganglia CMBs, and 13 patients (11.21%) with mixed CMBs]. The difference was statistically significant ( P<0.05). After adjusting for triglyceride, location of infarcated lesions, and the degree of WMHs, further Logistic regression analysis revealed that severe CMBs ( OR = 6.139, 95% CI 1.377 - 27.375, P = 0.017), basal ganglia CMBs ( OR = 5.253, 95% CI 1.105 - 24.975, P = 0.037) and mixed CMBS ( OR = 5.098, 95% CI 1.197 - 21.704, P = 0.028) were independent risk factors of END in SAO patients. Conclusions:The location and degree of CMBs are closely related to the occurrence of END in patients with SAO. Severe CMBs, basal ganglia CMBs and mixed CMBs may be the effective predictors of END in patients with SAO.

Study on the correlation between the location and early neurological deterioration in isolated subcortical infarction / 中风与神经疾病杂志

@#Objective　To study the relationship between infarct location and early neurological deterioration（END) in isolated subcortical infarctions.Methods　We collected patients who were admitted with a diagnosis of isolated subcortical infarction.According to their infarct location,patients were divided into proximal infarct group and distal infarct group.National Institutes of Health Stroke Scale (NIHSS) score was used to assess the degree of neurological impairment in both groups on the day of admission and within 3 days after admission.If the NIHSS score increased by 2 points or more within 72 hours after admission,END was considered.Baseline data and the incidence of END were compared between groups.Finally,We screened the independent risk factors for early prediction of END.Results　A total of 422 cases were collected,68 of 239 cases with proximal infarct and 13 of 183 cases with distal infarct developed END.There were statistically significant differences in age,male,LDL,history of stroke,proximal infarct and carrier artery stenosis in END,compared with non-END.Logistic regression analysis showed that age,male,history of stroke,proximal infarct and carrier artery stenosis were independent risk factors for END.Conclusion　Patients with proximal infarct are more likely to develop END in isolated subcortical infarctions,which should arouse clinical attention.

Correlation between the trigiuceride-glucose index and early neurological deterioration in patients with mild ischemic stroke / 中风与神经疾病杂志

@#To investigate the correlation between the trigiuceride-glucose index and early neurological deterioration（END） in patients with mild ischemic stroke（MIS）. Methods This study was retrospective. Patients with acute MIS who were admitted to the Department of Neurology of the First Central Hospital of Baoding from January 2019 to December 2020 for the first time and within 72 h of onset were consecutively included. The National Institute of Health Stroke Scale（NIHSS） scores were recorded at the time of admission，and fasting venous blood was drawn in the early morning of the following day to determine routine blood，liver function，renal function，lipids and other relevant blood indices，and the trigiuceride-glucose index was calculated ln［TG（mg/dl）×FBG（mg/dl）］/2.The patients were divided into END and non-END groups according to their neurological deterioration. Multi-factor logistic regression was used to analyze the factors associated with the occurrence of END in acute MIS patients，and the subject operating characteristic curve（ROC） was used to evaluate the predictive effect of the trigiuceride-glucose index on END in acute MIS patients. Results A final total of 149 patients with acute MIS were included，39 in the END group and 110 in the non-END group. Multi-factor logistic regression analysis showed that neutrophil ratio（OR 1.054，95%CI 1.009～1.101，P=0.017）、TBIL（OR 0.718，95%CI 0.611～0.845，P<0.001）and trigiuceride-glucose index（OR 5.072，95%CI 1.645～15.640，P=0.005） were independent risk factors for the development of END in patients with acute MIS. The ROC curve analysis showed that the diagnostic cut-off value of trigiuceride-glucose index for END was 1.74 with a sensitivity of 53.8% and specificity of 81.8%. Conclusion Elevated trigiuceride-glucose index is one of the risk factors for the development of END in patients with acute MIS and has a predictive role for the development of END in patients with acute MIS.

Safety and efficacy of low dose tirofiban for patients with branch atheromatous disease after intravenous thrombolysis / 中风与神经疾病杂志

@#Objective　To investigate the efficacy and safety of early application of tirofiban after intravenous thrombolysis in patients with branch atheromatous disease.Methods　We retrospectively analyzed data collected from patients with BAD who were admitted to our hospital from March 2017 to July 2021.Subjects were classified into the alteplase-only control group and the alteplase+tirofiban treatment group.A propensity score matching analysis was performed to control substantial heterogeneity of subgroup.We compared the incidence of early neurological deterioration end,the rapeutic effect and bleeding risk between the two groups.Results　The incidence of early neurological deterioration was lower in the tirofiban treatment group than in the control group on day 1 (P<0.05).NHISS score were higher on day 1 and day 7 in the tirofiban treatment group as compared to the control group (P<0.05).MRS score on 90 days were higher in the tirofiban treatment group as compared to the control group (P<0.05).When compared to the control group,the proportion of patients with a favorable outcome (mRS,0~1 point) three months after stroke was greater in the tirofiban therapy group.The proportion of patients with dependence (mRS≥4 points) was lower in the tirofiban treatment group than in the control group.There was no case of intracranial hemorrhage in either group.Conclusion　Early adding low-dose tirofiban after intravenous thrombolysis could reduce early neurological deterioration and improve the long-term prognosis of patients with branch atheromatous disease.

Correlation between white matter hyperintensity and early neurological deterioration after intravenous recombinant tissue plasminogen activator thrombolysis in acute ischemic stroke patients / 中华神经医学杂志

Objective:To investigate the effects of white matter hyperintensity (WMH) of different lesion areas and severities on early neurological deterioration (END) in acute ischemic stroke (AIS) patients after intravenous recombinant tissue plasminogen activator (rt-PA) thrombolysis.Methods:Three hundred and seventy-three AIS patients, admitted to our hospital from April 2019 to July 2021, were chosen in our study. These patients were treated with intravenous rt-PA thrombolysis within 4.5 h of onset. According to the presence or absence of END, these patients were divided into END group ( n=89) and non-END group ( n=284). Fazekas scale was used to assess the periventricular WMH (PVWMH) and subcortical WMH (SCWMH): none-mild PVWMH/SCWMH was defined at 0-1 score and moderate to severe PVWMH/SCWMH was defined at 2-3 scores; the sum scores of the two sites were calculated, and none-mild WMH was defined at 0-2 scores and moderate-severe WMH was defined at 3-6 scores. Univariate analysis was used to compare the baseline data of the two groups, and multivariate Logistic regression was used to determine the correlations of END with WMH lesion areas and severities. Results:Univariate analysis showed that there was significant difference between the END group and non-END group in age, baseline blood glucose, baseline National Institutes of Health Stroke Scale (NIHSS) scores, Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, hemorrhagic transformation after thrombolysis, and PVWMH, SCWMH, and WMH scores ( P<0.05). Multivariate Logistic analysis showed that only baseline NIHSS scores ( OR=1.064, 95%CI: 1.019-1.111, P=0.005), hemorrhagic transformation after thrombolysis ( OR=3.931, 95%CI: 2.007-7.701, P=0.000), moderate-severe WMH ( OR=4.736, 95%CI: 2.737-8.195, P=0.000), and moderate-severe SCWMH ( OR=5.557, 95%CI: 3.156-9.783, P=0.000) were independently related to the occurrence of END. Conclusion:Patients with moderate-severe SCWMH, moderate-severe WMH, or high NIHSS scores after thrombolysis trend to have END.

Correlation between fibrinogen and lipoprotein (a) and early neurological deterioration in acute ischemic stroke patients with diabetes / 国际脑血管病杂志

Objective:To investigate the correlation between fibrinogen and lipoprotein (a) and early neurological deterioration (END) in acute ischemic stroke patients with diabetes.Methods:From January 2017 to December 2020, patients with acute ischemic stroke admitted to the Department of Neurology, Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University within 48 h of onset were enrolled retrospectively. END was defined as the National Institutes of Health Stroke Scale (NIHSS) score within 7 d after onset increased by ≥2 or motor function score increased by ≥1 compared with the baseline. Demographic and baseline clinical data were collected. Multivariate logistic regression analysis was used to identify the independent risk factors for END in general and diabetic patients with acute ischemic stroke. Results:A total of 1 504 patients with acute ischemic stroke were enrolled. Two hundred and fifty-two (16.76%) patients had END. The age, baseline NIHSS score, random blood glucose, fibrinogen, lipoprotein (a) levels, and the proportion of patients with diabetes in the END group were higher than those in the non-END group. There were also significant differences in various stroke etiologic subtypes between the END group and the non-END group (all P<0.05). Multivariate logistic regression analysis showed that fibrinogen and lipoprotein (a) levels were not the independent risk factors for END in patients with acute ischemic stroke. Three hundred and thirty-seven patients also had diabetes mellitus, of which 85 had END (25.22%). The levels of fibrinogen and lipoprotein (a) in the END group were significantly higher than those in the non-END group ( P<0.05). Multivariate logistic regression analysis showed that fibrinogen (odds ratio 2.23, 95% confidence interval 1.75-4.54; P=0.002) and lipoprotein (a) (odds ratio 1.98, 95% confidence interval 1.57-3.65; P=0.003) were the independent risk factors for END in acute ischemic stroke patients with diabetes. Conclusion:Higher fibrinogen and lipoprotein (a) levels are associated with END in acute ischemic stroke patients with diabetes.

Transcranial color Doppler ultrasound quantitative analysis of the risk of early neurological deterioration in acute ischemic stroke patients and its effectiveness in predicting poor prognosis / 中国医师进修杂志

Objective:To investigate the ability of predicting poor prognosis and the diagnosis efficacy of transcranial color Doppler ultrasound (TCCD) in acute ischemic stroke patients.Methods:A total of 264 AIS patients admitted to the Second Hospital of Dalian Medical University from January 2018 to March 2020 were selected and divided into early neurological deterioration (END) group (55 patients) and no END group (209 patients). The optic nerve sheath diameter (ONSD)/transverse eyeball diameter (ETD), middle cerebral artery pulsatility index (PI) and midline shift were detected by TCCD, and the results were analyzed.Results:The values of ONSD/ETD, PI and midline shift in the END group were higher than those in the no END group: 0.24 ± 0.02 vs. 0.22 ± 0.03, 1.26 ± 0.14 vs. 1.10 ± 0.12, (4.97 ± 1.13) mm vs. (3.41 ± 1.05) mm, and the differences were statistically significant ( P<0.05). The values of ONSD/ETD, PI, midline shift in the brain were positively correlated with the National Institutes of Health Stroke Scale (NIHSS) scores ( r1 = 0.531, r2 = 0.599, r3 = 0.566, all P<0.001). Multivariate analysis showed that NIHSS scores, blood glucose, ONSD/ETD, PI, brain midline shift values were related to END ( P<0.05). The prognostic area under the curve of the ONSD/ETD, PI, combined with brain midline shift values in assessing prognosis was 0.896, which was greater than any single index. The sensitivity was 84.62%, and the specificity was 89.08%. Conclusions:The detection of ONSD/ETD, PI and midline shift values by TCCD can provide important information for clinical assessment of the risk of END in AIS patients.

Predictive value of Cystatin C for Early Neurological Deterioration in patients with incipient Acute Cerebral Infarction / 中风与神经疾病杂志

@#Objective To investigate the predictive value of Cystatin C（Cys-C） for Early Neurological Deterioration（END） in patients with incipient Acute Cerebral Infarction（ACI） that has normal renal function. Methods A total of 243 patients with primary ACI and no chronic kidney disease who were admitted to Department of Neurology，the Third Affiliated Hospital of Jinzhou Medical University from July 2019 to July 2020 were selected. All patients were examined by CT and MR. The patients were divided into END group and non-END group according to the variation of NIHSS score within 72 hours after admission. Compare the general baseline data of the two groups of patients and the laboratory indicators examined for the first time on admission. Determine the factors that may affect the occurrence of END by univariate analysis and multivariate Logistic regression analysis，and analyze the predictive value of Cys-C on the occurrence of the END of ACI by using Receiver Operating Characteristic（ROC） curve.Results Cys-C level of END group was significantly higher than that of non-END group，and the difference was statistically significant（P<0.05）.Logistics regression analysis suggests that Cys-C level is an independent risk factor for the END of ACI. ROC curve showed that the area under the curve of Cys-C for predicting the occurrence of ACI’s END was 0.745［95%CI（0.661，0.828）］，indicating that serum Cys-C had a moderate predictive value for the occurrence of END.The Youden index was 0.385，the predictive critical value was 1.845mg/L，the sensitivity was 65.8%，and the specificity was 72.7%.Conclusion Cys-C has predictive value for the occurrence of END，and the predictive value is relatively high.When the level of Cys-C is higher than 1.845mg/L，the probability of the occurrence of END is the highest.

The value of diffusion weighted imaging-Alberta stroke project early CT score in predicting early neurological deterioration in patients with acute anterior circulation cerebral infarction / 中风与神经疾病杂志

@#Objective　To explore the value of diffusion weighted imaging-Alberta stroke project early CT score (DWI-ASPECTS) in predicting early neurological deterioration (END) in the patients with acute anterior circulation cerebral infarction.Methods　The data patients with acute anterior circulation cerebral infarction treated in the department of neurology of our hospital from October 01 2014 to June 30 2016 were retrospectively analyzed.According to the occurrence of END.The patients were divided into END group and non-END group.The differences of clinical variables between the two groups were analyzed and compared.ROC curve was used to evaluate the predictive value of DWI-ASPECTS score in the patients with acute anterior circulation cerebral infarction.Results　The DWI-ASPECTS score of END group was significantly lower than that of non-END group (P<0.001).The DWI-ASPECTS (95%CI 0.466~0.8,95% CI 0.466~0.8 95% score 0.009) and the LDL-C (95% CI 1.006~2.316 score 0.047) were independent risk factors for END.ROC curve shows that when the DWI-ASPECTS is 7 as the cut-off point.The area under the curve is 0.769 (95%CI 0.715~0.818),the sensitivity is 61.54% and the specificity is 88.04%.Conclusion　DWI-ASPECTS has a good predictive value in the patients with acute anterior circulation cerebral infarction.Which should be further verified by a large sample study.

The predictive value of plasma ADMA level in early neurological deterioration in patients with acute cerebral infarction / 中风与神经疾病杂志

@#Objective To observe the expression of asymmetric dimethylarginine (ADMA) in the plasma of patients with acute cerebral infarction (ACI),and to explore its predictive value for the early neurological deterioration (END) in ACI. Methods From September 2016 to June 2019,100 patients with acute cerebral infarction confirmed and hospitalized in our hospital were selected as the observation group,and 100 healthy people who were examined in our hospital at the same time as the control group,the expression of ADMA in the plasma of patients with acute cerebral infarction was detected by enzyme-linked immunosorbent assay (ELISA);Pearson method was used to analyze the correlation of ADMA expression with NIHSS score and infarct area;receiver operating characteristic curve (ROC) was used to analyze the predictive value of ADMA expression on END in patients with acute cerebral infarction;and Logistic regression analysis was used to analyze the influencing factors of END in patients with acute cerebral infarction. Results The proportions of hypertension,diabetes,hyperlipidemia and drinking history in the observation group were higher than those in the control group (P<0.05);the expression of ADMA in plasma of END group was higher than that of non END group,and NIHSS score and infarct area of END group were higher than those of non END group (P<0.05);the expression of ADMA in plasma of patients with acute cerebral infarction was positively correlated with NIHSS score and infarct area (r= 0.547,0.590,P<0.05);the area under ROC curve of ADMA predicting END in patients with acute cerebral infarction was 0.779,the cutoff value was 0.883 μmol/L,the sensitivity was 67.7%,and the specificity was 78.3%;Logistic regression analysis showed that ADMA high expression,NIHSS score and infarct area were the risk factors of END in patients with acute cerebral infarction. Conclusion The expression of ADMA in patients with acute cerebral infarction is high,which may be related to END,it is a risk factor of END in patients with acute cerebral infarction,and can be used as a better index to predict the occurrence of END in patients with acute cerebral infarction.

Reliability of C-reactive protein as a predictor of early neurological deficit in acute ischemic stroke: is it only to be blamed? a retrospective observational study

Background: Ischemic Stroke is a common cause of morbidity and mortality. Various parameters, both clinical and laboratory have been studied as markers of Early Neurological Deterioration (END) out of which CRP has been the most important. This retrospective study of ours is an attempt to study its influence on END by minimizing other variables as much as possible.Methods: 50 patients were chosen retrospectively strictly according to laid down inclusion and exclusion criteria, their data recorded and analyzed with 17.0 SPSS software. Any p value <0.05 was taken as significant.Results: Significantly raised CRP values were found in elderly patients (p=0.0001) and in males (p=0.003). Higher incidences of ENDs were also found in elderly patients (p=0.326) and males (p=0.846) and patients with raised CRP levels (p=0.057).Conclusions: Higher Values of CRP are associated with increased frequency of ENDs. But in patients with multiple factors which can influence both CRP and END, CRP alone should not be thought of as the only culprit.

Clinical predictors of early neurological deterioration in patients with acute minor ischemic stroke

@#Background: Early neurological deterioration is a critical determinant of functional outcome in patients with acute minor ischemic stroke. This study aimed to identify clinical predictors of early neurological deterioration in patients with acute minor ischemic stroke. Methods: A total of 739 patients who experienced acute minor ischemic stroke symptoms between January 2014 and December 2018 were enrolled in this study. All patients were presented within a 4.5-hour time window of stroke symptom onset. Early neurological deterioration was defined as an increment of at least one point in motor power or total National Institute of Health Stroke Scale (NIHSS) score deterioration ≥ 2 points within 3 days after admission. Unfavorable functional outcome was defined as a modified Rankin Scale score of ≥ 2 at 90 days after stroke onset. Demographic characteristics, risk factors for vascular diseases, stroke severity, stroke subtypes, and neuroimaging parameters were analyzed. Regression analysis was used to determine clinical predictors of early neurological deterioration. Results: Of the 739 patients, 78 (10.5%) patients had early neurological deterioration. Among the 78 patients with early neurological deterioration, 61 (78.2%) had unfavorable functional outcome at 90 days after stroke onset. In contrast, 131 of the remaining 661 (19.8%) patients without early neurological deterioration had unfavorable functional outcome. Multivariate analysis identified hemorrhagic transformation (odds ratio, 3.8; 95% confidence interval, 1.4-10.5; P = 0.010), higher NIHSS score at admission (odds ratio, 1.4; 95% confidence interval, 1.1-1.7; P = 0.003), arterial stenosis (odds ratio, 2.0; 95% confidence interval, 1.2-3.5; P = 0.014) and occlusion (odds ratio, 2.6; 95% confidence interval, 1.4-4.8; P = 0.004) in the territory of stroke as significant predictors of early neurological deterioration. Conclusions: The results of this study suggest that hemorrhagic transformation, higher NIHSS score at admission, and arterial steno-occlusive lesions in the territory of stroke are independent predictors of early neurological deterioration in patients with acute minor ischemic stroke.

Analysis of influencing factors of early neurological deterioration in acute cerebral infarction patients with middle cerebral artery occlusion / 中风与神经疾病杂志

@#Objective　To analyze the influencing factors of early neurological deterioration in acute cerebral infarction patients with middle cerebral artery (MCA) occlusion.Methods　One hundred and thirty-four acute cerebral infarction patients with MCA occlusion in the department of neurology of our hospital from January 2017 to December 2019 were enrolled retrospectively.The definition of early neurological deterioration (END) was the national institutes of health stroke scale (NIHSS) score increased by ≥ 2 compared with the baseline NIHSS score of admission within 72 hours.Forty-eight cases in END group and 86 cases in non-END group.Baseline and clinical data at admission were compared between the two groups.Binary multivariate logistic regression analysis were used to assess the influencing factors of END in acute cerebral infarction patients with MCA occlusion.Results　(1)Gender,age,time of onset,admission NIHSS score,collateral circulation and parameters of blood pressure variability (SBPsd,SBPcv,SBPmax-min,DBPsd,DBPcv,DBPmax-min) were statistically significant between non-END group and END group.(2)Multivariate logistic regression analysis suggested that poor collateral circulation(OR=8.330，95%CI 1.629~42.587,P=0.011) and SBPmax-min (OR=1.139,95%CI 1.032~1.258,P=0.01) were independent risk factors for END in acute cerebral infarction patients with MCA occlusion.SBPmax-min predicted effectively END with best cutoff value 35.5,sensitivity 93.8%,specificity 64% and AUC0.85 (95%CI 0.788~0.912,P<0.001).Conclusion　There were many factors affecting END in patients with acute cerebral infarction with MCA occlusion.Poor collateral circulation and Blood pressure variability (BPV) were independent risk factors for END.

Influencing factors of early neurological deterioration after intravenous thrombolysis in acute cerebral infarction / 中国脑血管病杂志

Objective: To investigate influencing factors of early neurological deterioration (END) in acute cerebral infarction patients after intravenous thrombolysis. Methods: From March to August in 2018,a total of 139 consecutive acute cerebral infarction patients receiving intravenous thrombolysis within 4.5 h after onset in Department of Neurology of Xuanwu Hospital, Capital Medical University were recruited These patients included 116 males and 23 females. According to the presence of END after intravenous thrombolysis, the patients were divided into the END group (n =25) and the non-END group (n = 114). Baseline and clinical data were collected and compared between the two groups,including age,sex,past medical history (hypertension,diabetes,coronary heart disease,congenital heart disease,atrial fibrillation,hyperlipidemia, ischemic stroke [cerebral infarction, transient ischemic attack]), smoking, the National Institute of Health Stroke Scale (NIHSS), low-density lipoprotein cholesterol, blood glucose, blood pressure, proportion of anterior circulation infarction and the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. Multivariate logistic regression analysis was performed for END incidence of these patients with the parameters of P 0. 05). (4) The large-artery atherosclerosis rate of the END group was significantly higher than that of the non-END group (76. 0% [19/25]vs. 45. 6% [52/114],χ2 =7. 576, P0.05). Conclusion Large-artery atherosclerosis in TOAST classification can increase the risk of END after intravenous thrombolysis in patients with acute cerebral infarction.

Lipoprotein-associated phospholipase A2 predicts early neurological deterioration in patients with lacunar infarction / 中国脑血管病杂志

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.