Early neurological deterioration in patients with acute ischemic stroke: a prospective multicenter cohort study

Therapeutic Advances in Neurological Disorders, Journal Year: 2023, Volume and Issue: 16

Published: Jan. 1, 2023

There is still no precise knowledge of the causes progression in patients with acute ischemic stroke (AIS), and we are unable to predict at risk.To explore frequency, predictive factors, prognosis early neurological deterioration (END) AIS.In this prospective multicenter observational study, assessed AIS admitted 18 hospitals Henan, China. We defined END as an increase ⩾2 points total National Institutes Health Stroke Scale (NIHSS) score or ⩾1 point motor items NIHSS within 7 days after admission. Risk factors were analyzed using multivariate logistic regression models. Prognosis was evaluated modified Rankin (mRS), poor mRS 3-6.A 9114 24 h symptom onset enrolled study. occurred 1286 (14.1%) patients. The highest incidence (62.5%) After adjusting potential confounders, age, body mass index, waist-hip ratio, systolic blood pressure, baseline NIHSS, disabled baseline, history atrial fibrillation, diabetes mellitus, intracranial arterial stenosis, infarct location lenticulostriate artery area cerebral watershed, neutrophils, lymphocytes, uric acid, triglycerides identified independent predictors for END. significantly associated 90 days, adjusted OR 1.74 (95% CI: 1.53-1.97).One seven hospitalized may experience onset. admission decreased steeply time. Easily identifiable risk could help understand causal mechanisms thereby prevent

Language: Английский

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Association between systemic inflammatory indicators with the survival of chronic kidney disease: a prospective study based on NHANES

Frontiers in Immunology, Journal Year: 2024, Volume and Issue: 15

Published: April 8, 2024

Background systemic inflammation disorders were observed in chronic kidney disease (CKD). Whether the inflammatory indicators could be optimal predictors for survival of CKD remains less studied. Methods In this study, participants selected from datasets National Health and Nutrition Examination Survey (NHANES) between 1999 to 2018 years. Four evaluated by peripheral blood tests including immune-inflammation index (SII, platelet*neutrophil/lymphocyte), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte (PLR), lymphocyte-to-monocyte (LMR). Kaplan-Meier curves, restricted cubic spline (RCS), Cox regression analysis used evaluate association with all-cause mortality CKD. Receiver operating characteristic (ROC) concordance (C-index) determine predictive accuracy varied indicators. Sensitive analyses conducted validate robustness main findings. Results A total 6,880 included study. The mean age was 67.03 years old. Among study population, levels 588.35 SII, 2.45 NLR, 133.85 PLR, 3.76 LMR, respectively. PLR all significantly positively associated patients, whereas high value LMR played a protectable role patients. NLR leading patients [Hazard (HR) =1.21, 95% confidence interval (CI): 1.07-1.36, p = 0.003 (3 rd quartile), HR 1.52, 95%CI: 1.35-1.72, p<0.001 (4 th quartile) 0.83, 0.75-0.92, (2 nd 0.73, 0.65-0.82, 0.74, 0.65-0.83, LMR], C-index 0.612 0.624, RCS curves showed non-linearity risk population. Conclusion Our highlights that are important predicting U.S. population would add additional clinical health care

Language: Английский

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Understanding Why Post-Stroke Depression May Be the Norm Rather Than the Exception: The Anatomical and Neuroinflammatory Correlates of Post-Stroke Depression

Journal of Clinical Medicine, Journal Year: 2021, Volume and Issue: 10(8), P. 1674 - 1674

Published: April 14, 2021

Ischemic Stroke precedes depression. Post-stroke depression (PSD) is a major driver for poor recovery, negative quality of life, rehabilitation outcomes and functional ability. In this systematic review, we analysed the inflammatory basis post-stroke depression, which involves bioenergetic failure, deranged iron homeostasis (calcium influx, Na potassium efflux etc), excitotoxicity, acidotoxicity, disruption blood brain barrier, cytokine-mediated cytotoxicity, reactive oxygen mediated toxicity, activation cyclooxygenase pathway generation toxic products. This process subsequently results in cell death, maladapted, persistent neuro-inflammation neuronal networks mood-related regions. Furthermore, an in-depth review likewise reveals that anatomic structures related to may be localized complex circuitries involving cortical subcortical

Language: Английский

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The relationship between systemic inflammation index, systemic immune-inflammatory index, and inflammatory prognostic index and 90-day outcomes in acute ischemic stroke patients treated with intravenous thrombolysis

Journal of Neuroinflammation, Journal Year: 2023, Volume and Issue: 20(1)

Published: Sept. 30, 2023

To explore the association of systemic inflammatory index (SIRI), immune-inflammatory (SII) and prognosis (IPI) with 90d outcomes in patients acute ischemic stroke (AIS) after intravenous thrombolysis.The who underwent thrombolysis were enrolled present study from September 2019 to December 2022. According relevant blood indexes obtained 24 h admission, corresponding values SIRI, SII IPI calculated. The correlation among SII, IPI, admission NIHSS scores was examined by Spearman analysis. ROC curve analysis conducted determine optimal cut-off value their sensitivity specificity evaluate predictive on for poor prognosis. investigate whether high independent predictors within 90 days, variables P-value < 0.05 during univariate included multivariate analysis.Compared good outcome group, group had higher SII. showed that levels significantly correlated score (r = 0.338, 0.356, 0.427, respectively; Ps 0.001). Univariate Multivariate logistic regression revealed as risk factors 90-day (OR 1.09, 1.003 7.109, respectively).High are AIS undergoing thrombolysis.

Language: Английский

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Associations between systemic inflammation indicators and nonalcoholic fatty liver disease: evidence from a prospective study

Frontiers in Immunology, Journal Year: 2024, Volume and Issue: 15

Published: June 24, 2024

Background Although inflammation has been linked to nonalcoholic fatty liver disease (NAFLD), most studies have focused only on a single indicator, leading inconsistent results. Therefore, large prospective study that includes variety of well-documented and composite indicators is needed. This aimed thoroughly investigate the potential associations between different systemic inflammatory NAFLD in UK Biobank cohort. Methods After excluding ineligible participants, 378,139 individuals were included study. Associations hepatic steatosis assessed using multivariate logistic regression. The relationships analysed Cox proportional hazards models, nonlinear investigated restricted cubic splines. Results According cross-sectional analysis, significantly correlated with steatosis. Over median follow-up 13.9 years, 4,145 developed NAFLD. sufficient adjustment for confounding factors, CRP levels found be nonlinearly positively associated risk ( P &lt;0.001), representing strongest correlation among tested relationships; lymphocyte count LMR showed an L-shaped correlation; monocyte neutrophil linear positive (all &lt; 0.001); NLR, PLR, SII U-shaped &lt;0.001). Conclusions Multiple are strongly development NAFLD, aggressive management may favourable impact reducing burden NAFLD; further randomized controlled

Language: Английский

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Low HALP (Hemoglobin, Albumin, Lymphocyte, and Platelet) Score Increases the Risk of Post-Stroke Cognitive Impairment: A Multicenter Cohort Study

Clinical Interventions in Aging, Journal Year: 2024, Volume and Issue: Volume 19, P. 81 - 92

Published: Jan. 1, 2024

Objective: The HALP (hemoglobin, albumin, lymphocyte, and platelet) score is a novel indicator that measures systemic inflammation nutritional status has not been correlated with the risk of post-stroke cognitive impairment in patients acute ischemic stroke or transient attack (TIA). Methods: Study participants were recruited from 40 centers China. was derived using weighted sum hemoglobin, lymphocytes platelets, study categorized into 4 groups equal sizes based on quartiles cutoffs score. Montreal Cognitive Assessment (MoCA)-Beijing Scale (MoCA-Beijing) performed at 2 weeks 12 months following onset. Post-stroke considered MoCA-Beijing≤ 22. Multiple logistic regression methods employed to evaluate relationship between subsequent developing impairment. Results: population comprised 1022 (mean age 61.6± 11.0 years, 73% men). proportion individuals 22 49.2% 32.4% one year. Patients lowest quartile (< 36.56) observed harbor highest post-stroke/TIA compared those (odds ratio=1.59, 95% CI=1.07– 2.37, p=0.022), lower domain scores for executive function, naming, attention. There no statistically significant differences different post-stroke/TIA. Conclusion: simple could stratify stroke/TIA facilitate early diagnosis interventions. Keywords: mild stroke, post impairment, platelet

Language: Английский

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The association between the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio and delirium in ischemic stroke patients

Frontiers in Medicine, Journal Year: 2025, Volume and Issue: 11

Published: Jan. 6, 2025

Delirium is a severe neuropsychiatric symptom following acute ischemic stroke (IS) and associated with poor outcomes. Systemic inflammation immune dysregulation are believed to contribute the pathophysiology of delirium. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte (PLR), lymphocyte-to-monocyte (LMR) widely recognized as convenient reliable biomarkers systemic inflammation. However, their association delirium after IS remains unclear. In this study, we identified patients requiring ICU admission from Medical Information Mart for Intensive Care (MIMIC)-IV database. We employed multivariable logistic regression restricted cubic splines (RCS) assess between NLR, PLR, LMR Two-sample Mendelian randomization (MR) analysis was performed further explore causal relationship at genetic level. A total 1,436 were included in whom 214 (14.9%) had multivariate analysis, adjustment confounders, highest quartile NLR (odds [OR] 2.080, 95% confidence interval [CI], 1.282-3.375) (OR 0.503, CI 0.317-0.798) second PLR 1.574, 1.019-2.431) significantly RCS function showed progressive increase risk higher lower LMR. MR only negatively observational studies found significant associations demonstrated potential protective Further prospective needed validate elucidate underlying mechanisms.

Language: Английский

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The Role of Mature Brain-Derived Neurotrophic Factor and Its Precursor in Predicting Early-Onset Insomnia in Stroke Patients Experiencing Early Neurological Deterioration

Nature and Science of Sleep, Journal Year: 2025, Volume and Issue: Volume 17, P. 315 - 327

Published: Feb. 1, 2025

Background: The investigation and management of early-onset insomnia (EOI) in patients undergoing early neurological deterioration (END) appear to be insufficiently prioritized clinical practice. Brain-derived neurotrophic factor (mBDNF) its precursor, proBDNF, play essential roles neuroplasticity may involved the pathophysiological mechanisms underlying EOI. This study aimed investigate associations serum mBDNF, mBDNF/proBDNF ratio with EOI stroke experiencing END. Methods: In a prospective cohort from October 2021 December 2023, 232 END 56 healthy controls (HCs) were enrolled. Serum levels mBDNF proBDNF quantified using enzyme-linked immunosorbent assays. was diagnosed according International Classification Sleep Disorders, Third Edition (ICSD-3). Patients categorized into subgroups based on presence or absence Results: significantly lower compared those HCs (all p < 0.05). Among patients, 82 (35.3%) developed Those had without 0.001). Multivariate logistic regression analysis revealed that male gender ( = 0.026), Hamilton Depression Rating Scale (HAMD) scores 0.001), 0.009), 0.001) independent predictors patients. areas under curve (AUC) for 0.686 0.778, respectively. Conclusion: Our identified correlation between reduced decreased development addition, provide greater insight as promising biomarker than alone. Keywords: brain-derived factor, ischemic stroke, insomnia, deterioration,

Language: Английский

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A predictive model for early neurological deterioration after intravenous thrombolysis in patients with ischemic stroke

Frontiers in Neurology, Journal Year: 2025, Volume and Issue: 16

Published: Feb. 17, 2025

Objective Intravenous thrombolysis (IVT) is the treatment of choice for acute ischemic stroke (AIS), but some patients develop early neurological deterioration (END) within 24 h after IVT. Therefore, we aimed to identify predictors END in AIS following with Methods We retrospectively analyzed clinical data 621 who received IVT recombinant tissue-type plasminogen activator (rt-PA) at Stroke Centre People’s Hospital Lu’an City, China, from July 2018 2023. Clinical data, including demographic characteristics, assessment results, underlying diseases, and laboratory indices, were collected time admission. The divided into training validation cohorts, which LASSO regression was applied select most important predictor variables, multivariate logistic used construct a nomogram. discriminative power model determined by calculating area under curve (AUC), calibration decision analyses (DCA) performed. Results platelet-to-lymphocyte ratio (PLR) (OR 1.01, 95% CI 1.01–1.01, p &lt; 0.001), mean platelet corpuscular volume (MPV) 2.12, 1.67–2.69, admission NIHSS score 1.25, 1.16–1.36, 0.001) significantly associated development END. AUC prediction constructed these three factors 0.896 (95% 0.862–0.93), close diagonal. Conclusion This predictive can be identification risk developing active interventions improve prognosis AIS.

Language: Английский

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Associations of Inflammatory Markers With Neurological Dysfunction and Prognosis in Patients With Progressive Stroke

European Journal of Neurology, Journal Year: 2025, Volume and Issue: 32(2)

Published: Feb. 1, 2025

ABSTRACT Objective This study aimed to explore the associations between inflammatory markers and severity of early neurological dysfunction prognosis in patients with progressive stroke (PS) evaluated predictive value for PS. Methods Among 711 acute ischemic (AIS) patients, 210 PS 501 without were included. Six markers, including neutrophil lymphocyte ratio (NLR), platelet (PLR), monocyte (LMR), systemic immune‐inflammation index (SII), response (SIRI), pan‐immune‐inflammation (PIV), measured compared two groups. Correlation analysis was used analyze correlation Univariate multivariate regression analyses applied screen factors patients. The receiver operating characteristic (ROC) curve utilized evaluate Results Elevated levels NLR, LMR, SII, PIV observed revealed positive correlations PLR, SIRI, PIV, deficits, while LMR showed a negative Multivariate identified National Institutes Health Stroke Score (NIHSS) as independent risk poor outcome alone limited (AUC = 0.59), but combining it NIHSS improved accuracy 0.73) ( p < 0.05). Conclusion These findings suggest that particularly should be considered management, their combination enhances prediction.

Language: Английский

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