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Jiang X, Hu Y, Wang J, Ma M, Bao J, Fang J, He L. Outcomes and risk factors for infection after endovascular treatment in patients with acute ischemic stroke. CNS Neurosci Ther 2024; 30:e14753. [PMID: 38727582 PMCID: PMC11086021 DOI: 10.1111/cns.14753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/12/2024] Open
Abstract
AIMS Infection is a common complication following acute ischemic stroke (AIS) and significantly contributes to poor functional outcomes after stroke. This study aimed to investigate the effects of infection after endovascular treatment (post-EVT infection) on clinical outcomes and risk factors in patients with AIS. METHODS We retrospectively analyzed AIS patients treated with endovascular treatment (EVT) between January 2016 and December 2022. A post-EVT infection was defined as any infection diagnosed within 7 days after EVT. The primary outcome was functional independence, defined as a modified Rankin scale (mRS) score of 0-2 at 90 days. A multivariable logistic regression analysis was conducted to determine independent predictors of post-EVT infection and the associations between post-EVT infection and clinical outcomes. RESULTS A total of 675 patients were included in the analysis; 306 (45.3%) of them had post-EVT infections. Patients with post-EVT infection had a lower rate of functional independence than patients without infection (31% vs 65%, p = 0.006). In addition, patients with post-EVT infection achieved less early neurological improvement (ENI) after EVT (25.8% vs 47.4%, p < 0.001). For safety outcomes, the infection group had a higher incidence of any intracranial hemorrhage (23.9% vs 15.7%, p = 0.01) and symptomatic intracranial hemorrhage (10.1% vs 5.1%, p = 0.01). Unsuccessful recanalization (aOR 1.87, 95% CI 1.11-3.13; p = 0.02) and general anesthesia (aOR 2.22, 95% CI 1.25-3.95; p = 0.01) were identified as independent predictors for post-EVT infection in logistic regression analysis. CONCLUSION AIS patients who develop post-EVT infections are more likely to experience poor clinical outcomes. Unsuccessful recanalization and general anesthesia were independent risk factors for the development of post-EVT infection.
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Affiliation(s)
- Xin Jiang
- Department of Neurology, West China HospitalSichuan UniversityChengduChina
| | - Yaowen Hu
- Department of Neurology, West China HospitalSichuan UniversityChengduChina
| | - Jian Wang
- Department of Neurology, West China HospitalSichuan UniversityChengduChina
| | - Mengmeng Ma
- Department of Neurology, West China HospitalSichuan UniversityChengduChina
| | - Jiajia Bao
- Department of Neurology, West China HospitalSichuan UniversityChengduChina
| | - Jinghuan Fang
- Department of Neurology, West China HospitalSichuan UniversityChengduChina
| | - Li He
- Department of Neurology, West China HospitalSichuan UniversityChengduChina
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Yu T, Liu H, Liu Y, Jiang J. Inflammatory response biomarkers nomogram for predicting pneumonia in patients with spontaneous intracerebral hemorrhage. Front Neurol 2023; 13:1084616. [PMID: 36712440 PMCID: PMC9879054 DOI: 10.3389/fneur.2022.1084616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 12/01/2022] [Indexed: 01/13/2023] Open
Abstract
Objectives Inflammatory response biomarkers are promising prognostic factors to improve the prognosis of stroke-associated pneumonia (SAP) after ischemic stroke. This study aimed to investigate the prognostic significance of inflammatory response biomarkers on admission in SAP after spontaneous intracerebral hemorrhage (SICH) and establish a corresponding nomogram. Methods The data of 378 patients with SICH receiving conservative treatment from January 2019 to December 2021 at Taizhou People's Hospital were selected. All eligible patients were randomized into the training (70%, 265) and validation cohorts (30%, 113). In the training cohort, multivariate logistic regression analysis was used to establish an optimal nomogram, including inflammatory response biomarkers and clinical risk factors. The area under the receiver operating characteristic (ROC) curve (AUC), calibration curve, and decision curve analysis (DCA) were used to evaluate the nomogram's discrimination, calibration, and performance, respectively. Moreover, this model was further validated in a validation cohort. Results A logistic regression analysis showed that intraventricular hemorrhage (IVH), hypertension, dysphagia, Glasgow Coma Scale (GCS), National Institute of Health Stroke Scale (NIHSS), systemic inflammation response index (SIRI), and platelet/lymphocyte ratio (PLR) were correlated with SAP after SICH (P < 0.05). The nomogram was composed of all these statistically significant factors. The inflammatory marker-based nomogram showed strong prognostic power compared with the conventional factors, with an AUC of 0.886 (95% CI: 0.841-0.921) and 0.848 (95% CI: 0.799-0.899). The calibration curves demonstrated good homogeneity between the predicted risks and the observed outcomes. In addition, the model has a significant net benefit for SAP, according to DCA. Also, internal validation demonstrated the reliability of the prediction nomogram. The length of hospital stay was shorter in the non-SAP group than in the SAP group. At the 3-month follow-up, clinical outcomes were worse in the SAP group (P < 0.001). Conclusion SIRI and PLR at admission can be utilized as prognostic inflammatory biomarkers in patients with SICH in the upper brain treated with SAP. A nomogram covering SIRI and PLR can more accurately predict SAP in patients' supratentorial SICH. SAP can influence the length of hospital stay and the clinical outcome.
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Affiliation(s)
- Tingting Yu
- Graduate School of Dalian Medical University, Dalian, China,Department of Neurology, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou, China,Department of Neurology, Taizhou People's Hospital, Taizhou, China
| | - Haimei Liu
- Graduate School of Dalian Medical University, Dalian, China,Department of Neurology, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou, China,Department of Neurology, Taizhou People's Hospital, Taizhou, China
| | - Ying Liu
- Department of Neurology, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou, China,Department of Neurology, Taizhou People's Hospital, Taizhou, China,Ying Liu ✉
| | - Jianxin Jiang
- Department of Neurosurgery, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou, China,Department of Neurosurgery, Taizhou People's Hospital, Taizhou, China,*Correspondence: Jianxin Jiang ✉
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Song X, Chen X, Bai J, Zhang J. Association between pre-stroke sarcopenia risk and stroke-associated infection in older people with acute ischemic stroke. Front Med (Lausanne) 2023; 10:1090829. [PMID: 36910490 PMCID: PMC9995446 DOI: 10.3389/fmed.2023.1090829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/27/2023] [Indexed: 02/25/2023] Open
Abstract
Background Stroke-associated infection (SAI) is a common complication after a stroke. The incidence of infection was higher in people with sarcopenia than in the general population. However, the relationship between pre-stroke sarcopenia risk and SAI in older patients has not been confirmed. This study aimed to investigate the association between pre-stroke sarcopenia risk and SAI in older patients with acute ischemic stroke (AIS). Methods This retrospective study was conducted by the Peking University People's Hospital. We evaluated the pre-stroke sarcopenia risk by applying the SARC-F questionnaire. Multivariate logistic regression was applied to explore the association between pre-stroke sarcopenia risk and SAI. Results A total of 1,002 elder patients with AIS (592 men; 72.9 ± 8.6 years) were enrolled in our study. Pre-stroke sarcopenia risk was found in 29.1% of the cohort. The proportion of patients with pre-stroke sarcopenia risk was larger in the SAI group than in the non-SAI group (43.2 vs. 25.3%, p < 0.001). In multivariate logistic analysis, pre-stroke sarcopenia risk was shown to be independently associated with SAI (OR = 1.454, 95% CI: 1.008-2.097, p = 0.045) after adjusting for potential factors. This association remained consistent across the subgroups based on age, sex, body mass index, smoking status, drinking status, diabetes, hypertension, and dyslipidemia. Conclusion Pre-stroke sarcopenia risk was independently associated with SAI in older patients with AIS. Our findings highlight the significance of pre-stroke sarcopenia identification in the prevention and management of SAI in this population.
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Affiliation(s)
- Xiaodong Song
- Department of Neurology, Peking University People's Hospital, Beijing, China
| | - Xufeng Chen
- Department of Neurology, Beijing Jishuitan Hospital, Beijing, China
| | - Jie Bai
- Department of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jun Zhang
- Department of Neurology, Peking University People's Hospital, Beijing, China
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Sharma D, Bhaskar SMM. Prognostic Role of the Platelet-Lymphocyte Ratio in Acute Ischemic Stroke Patients Undergoing Reperfusion Therapy: A Meta-Analysis. J Cent Nerv Syst Dis 2022; 14:11795735221110373. [PMID: 35860715 PMCID: PMC9290168 DOI: 10.1177/11795735221110373] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Both inflammation and thrombotic/hemostatic mechanisms may play a role in acute ischemic stroke (AIS) pathogenesis, and a biomarker, such as the platelet-to-lymphocyte ratio (PLR), considering both mechanisms may be of clinical utility. Objectives This meta-analysis sought to examine the effect of PLR on functional outcomes, early neurological changes, bleeding complications, mortality, and adverse outcomes in AIS patients treated with reperfusion therapy (RT). Design Systematic Review and Meta-Analysis Data Sources and Methods Individual studies were retrieved from the PubMed/Medline, EMBASE and Cochrane databases. References thereof were also consulted. Data were extracted using a standardised data sheet, and systematic reviews and meta-analyses on the association of admission (pre-RT) or delayed (post-RT) PLR with defined clinical and safety outcomes were conducted. In the case of multiple delayed PLR timepoints, the timepoint closest to 24 hours was selected. Results Eighteen studies (n=4878) were identified for the systematic review, of which 14 (n=4413) were included in the meta-analyses. PLR collected at admission was significantly negatively associated with 90-day good functional outcomes (SMD=−.32; 95% CI = −.58 to −.05; P=.020; z=−2.328), as was PLR collected at delayed timepoints (SMD=−.43; 95% CI = −.54 to −.32; P<.0001; z=−7.454). PLR at delayed timepoints was also significantly negatively associated with ENI (SMD=−.18; 95% CI = −.29 to −.08; P=.001. Conversely, the study suggested that a higher PLR at delayed timepoints may be associated with radiological bleeding and mortality. The results varied based on the type of RT administered. Conclusions A higher PLR is associated with worse outcomes after stroke in terms of morbidity, mortality, and safety outcomes after stroke.
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Affiliation(s)
- Divyansh Sharma
- Global Health Neurology and Translational Neuroscience Laboratory, Sydney and Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.,University of New South Wales (UNSW), South Western Sydney Clinical School, Sydney, NSW, Australia
| | - Sonu M M Bhaskar
- Global Health Neurology and Translational Neuroscience Laboratory, Sydney and Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.,University of New South Wales (UNSW), South Western Sydney Clinical School, Sydney, NSW, Australia.,Department of Neurology & Neurophysiology, Liverpool Hospital and South Western Sydney Local Health District (SWSLHD), Sydney, NSW, Australia.,NSW Brain Clot Bank, NSW Health Pathology, NSW, Sydney, Australia
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Korkut M, Selvi F, Bedel C. Echocardiographic epicardial fat thickness and immature granulocyte are novel inflammatory predictors of acute ischemic stroke: a prospective study. SAO PAULO MED J 2022; 140:384-389. [PMID: 35508005 PMCID: PMC9671256 DOI: 10.1590/1516-3180.2021.0461.r1.16082021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/16/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Acute ischemic stroke (AIS) is the most common type of stroke. Inflammation is the primary factor in the pathogenesis of atherosclerosis. Use of immature granulocytes (IGs) has been recommended as a new indicator of systemic inflammation. However, data on the association between echocardiographic epicardial fat tissue thickness (EFT) and IGs in patients with AIS are limited. OBJECTIVE To evaluate the association between the presences of IGs, epicardial fat tissue and AIS. DESIGN AND SETTING Prospective study in a tertiary-care university hospital in Antalya, Turkey. METHODS Our study included 53 AIS patients and 41 healthy controls with age and gender compatibility. Blood samples and transthoracic echocardiography of all participants were compared. RESULTS IG levels were significantly higher in patients with AIS than in controls (0.62 ± 0.36 versus 0.28 ± 0.02, P < 0.001). The mean EFT was 3.74 ± 0.61 mm in the control group and 6.33 ± 1.47 mm in the AIS patient group. EFT was significantly greater in AIS patients than in controls (P < 0.001). For the optimum cut-off value for IG (0.95), the area under the curve (AUC) was determined to be 0.840; sensitivity was determined to be 81.1% and specificity, 92.5%. For the optimum cut-off value for EFT (4.95 mm), the AUC was determined to be 0.953; sensitivity was determined to be 90.6% and specificity, 90%. CONCLUSIONS IG and echocardiographic EFT are clinical markers that can be used to predict AIS risk.
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Affiliation(s)
- Mustafa Korkut
- MD. Emergency Physician, Department of Emergency Medicine, Health Science University, Antalya Training and Research Hospital, Antalya, Turkey
| | - Fatih Selvi
- MD. Emergency Physician and Assistant Professor, Department of Emergency Medicine, Health Science University, Antalya Training and Research Hospital, Antalya, Turkey.
| | - Cihan Bedel
- MD. Emergency Physician, Department of Emergency Medicine, Health Science University, Antalya Training and Research Hospital, Antalya, Turkey.
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Sharma D, Spring KJ, Bhaskar SMM. Role of Neutrophil-Lymphocyte Ratio in the Prognosis of Acute Ischaemic Stroke After Reperfusion Therapy: A Systematic Review and Meta-analysis. J Cent Nerv Syst Dis 2022; 14:11795735221092518. [PMID: 35492740 PMCID: PMC9052237 DOI: 10.1177/11795735221092518] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 03/21/2022] [Indexed: 12/22/2022] Open
Abstract
Background Inflammation may mediate response to acute reperfusion therapy (RT) in acute
cerebral ischaemia. Neutrophil-lymphocyte ratio (NLR), an inflammatory
biomarker, may play an important role in acute ischaemic stroke (AIS)
prognostication. Objective This meta-analysis sought to examine the effect of NLR on functional
outcomes, mortality and adverse outcomes in AIS patients receiving RT. Methods Individual studies were retrieved from PubMed/Medline, EMBASE and Cochrane
databases. Data were extracted using a standardised data sheet and
meta-analysis on association of admission (pre-RT) or delayed (post-RT) NLR
with clinical/safety outcomes after RT was conducted. Results Thirty-five studies (n = 10 308) were identified for the systematic review
with 27 (n = 8537) included in the meta-analyses. Lower admission NLR was
associated with good functional outcomes (GFOs), defined as 3-month modified
Rankin scale (mRS) 0–2 (SMD = −.46; 95% CI = −.62 to −.29; P < .0001),
mRS 0–1 (SMD = −.44; 95% CI = −.66 to −.22; P < .0001) and early
neurological improvement (ENI) (SMD = −.55; 95 %CI = −.84 to −.25; P <
.0001). Lower delayed admission NLR was also associated with GFOs (SMD =
−.80; 95%CI = −.91 to −.68; P < .0001). Higher admission NLR was
significantly associated with mortality (SMD = .49; 95%CI = .12 to .85; P =
.009), intracerebral haemorrhage (ICH) (SMD = .34; 95% CI = .09 to .59; P =
.007), symptomatic ICH (sICH) (SMD = .48; 95% CI = .07 to .90; P = .022) and
stroke-associated infection or pneumonia (SMD = .85; 95% CI = .50, 1.19; P
< .0001). Higher delayed NLR was significantly associated with sICH (SMD
= 1.40; 95% CI = .60 to 2.19; P = .001), ICH (SMD = .94; 95% CI = .41 to
1.46; P < .0001) and mortality (SMD = 1.12; 95% CI = .57 to 1.67; P <
.0001). There were variations in outcomes across RT groups. Conclusion Higher admission or delayed NLR is significantly associated with worse
morbidity, mortality and safety outcomes in AIS patients receiving RT.
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Affiliation(s)
- Divyansh Sharma
- Global Health Neurology and Translational Neuroscience Laboratory, Sydney and Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
- South-Western Sydney Clinical School, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Kevin J. Spring
- South-Western Sydney Clinical School, University of New South Wales (UNSW), Sydney, NSW, Australia
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, NSW, Australia
- Medical Oncology Group, Liverpool Clinical School, Western Sydney University and Ingham Institute of Applied Medical Research, Sydney, NSW, Australia
| | - Sonu M. M. Bhaskar
- Global Health Neurology and Translational Neuroscience Laboratory, Sydney and Neurovascular Imaging Laboratory, Clinical Sciences Stream, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
- South-Western Sydney Clinical School, University of New South Wales (UNSW), Sydney, NSW, Australia
- NSW Brain Clot Bank, NSW Health Pathology, Sydney, NSW, Australia
- Department of Neurology & Neurophysiology, Liverpool Hospital and South-Western Sydney Local Health District, Comprehensive Stroke Center, Sydney, NSW, Australia
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Khanzadeh S, Lucke-Wold B, Eshghyar F, Rezaei K, Clark A. The Neutrophil to Lymphocyte Ratio in Poststroke Infection: A Systematic Review and Meta-Analysis. DISEASE MARKERS 2022; 2022:1983455. [PMID: 35313569 PMCID: PMC8934208 DOI: 10.1155/2022/1983455] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/21/2022] [Accepted: 02/11/2022] [Indexed: 02/08/2023]
Abstract
Ischemic and hemorrhagic strokes have multiple downstream consequences for patients. One of the most critical is poststroke infection (PSI). The goal of this systematic review and meta-analysis was to critically evaluate the literature regarding the use of the neutrophil to lymphocyte ratio (NLR) as a reliable means to detect early PSI development, particularly poststroke pneumonia (PSP) development to help clinicians institute early interventions and improve outcomes. The following were the inclusion criteria: (1) cross-sectional, case-control, and cohort studies; (2) studies comparing NLR data from PSI or PSP patients to controls; and (3) studies with a control group of stroke patients without infection. There was not any language or publication preference. The Newcastle-Ottawa Scale was used by two writers to assess the quality of the included studies. We assessed the certainty of the associations with GRADE methods. Web of Science, PubMed, and Scopus were searched, and 25 studies were included in the qualitative review. Among them, 15 studies were included in the meta-analysis. Standardized mean difference (SMD) was reported with a 95% confidence interval (CI) for the NLR levels. Patients with PSI had significantly higher NLR levels than stroke patients without infection (SMD = 1.08; CI 95% = 0.78-1.39, P value < 0.001). In addition, the NLR levels of the stroke patients with pneumonia were significantly higher than those without pneumonia (SMD = 0.98; CI 95% = 0.81-1.14, P value < 0.001). However, data extracted from the qualitative review suggested that NLR could not predict urinary tract infection, sepsis, or ventriculitis in stroke patients. Our study indicated that NLR could be recommended as an inexpensive biomarker for predicting infection, particularly pneumonia, in stroke patients. It can help clinicians institute early interventions that can reduce PSI and improve outcomes.
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Affiliation(s)
- Shokoufeh Khanzadeh
- 1Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Fatemeh Eshghyar
- 3Tehran University of Medical Sciences, School of Medicine, Tehran, Iran
| | - Katayoun Rezaei
- 4Student Research Committee, University of Kharazmi, Karaj, Iran
| | - Alec Clark
- 5University of Central Florida, School of Medicine, Orlando, USA
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Li J, Huang J, Pang T, Chen Z, Li J, Wu L, Hu Y, Chen W. Risk Estimation of Infectious and Inflammatory Disorders in Hospitalized Patients With Acute Ischemic Stroke Using Clinical-Lab Nomogram. Front Neurol 2021; 12:710144. [PMID: 34956037 PMCID: PMC8702498 DOI: 10.3389/fneur.2021.710144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/30/2021] [Indexed: 12/17/2022] Open
Abstract
Background: Infections after acute ischemic stroke are common and likely to complicate the clinical course and negatively affect patient outcomes. Despite the development of various risk factors and predictive models for infectious and inflammatory disorders (IAID) after stroke, more objective and easily obtainable predictors remain necessary. This study involves the development and validation of an accessible, accurate nomogram for predicting in-hospital IAID in patients with acute ischemic stroke (AIS). Methods: A retrospective cohort of 2,257 patients with AIS confirmed by neurological examination and radiography was assessed. The International Statistical Classification of Diseases and Health related Problem's definition was used for IAID. Data was obtained from two hospitals between January 2016 and March 2020. Results: The incidence of IAID was 19.8 and 20.8% in the derivation and validation cohorts, respectively. Using an absolute shrinkage and selection operator (LASSO) algorithm, four biochemical blood predictors and four clinical indicators were optimized from fifty-five features. Using a multivariable analysis, four predictors, namely age (adjusted odds ratio, 1.05; 95% confidence interval [CI], 1.038–1.062; p < 0.001), comatose state (28.033[4.706–536.403], p = 0.002), diabetes (0.417[0.27–0.649], p < 0.001), and congestive heart failure (CHF) (5.488[2.451–12.912], p < 0.001) were found to be risk factors for IAID. Furthermore, neutrophil, monocyte, hemoglobin, and high-sensitivity C-reactive protein were also found to be independently associated with IAID. Consequently, a reliable clinical-lab nomogram was constructed to predict IAID in our study (C-index value = 0.83). The results of the ROC analysis were consistent with the calibration curve analysis. The decision curve demonstrated that the clinical-lab model added more net benefit than either the lab-score or clinical models in differentiating IAID from AIS patients. Conclusions: The clinical-lab nomogram predicted IAID in patients with acute ischemic stroke. As a result, this nomogram can be used for identification of high-risk patients and to further guide clinical decisions.
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Affiliation(s)
- Junhong Li
- Department of Neurology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, China
| | - Jingjing Huang
- Department of Neurology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, China
| | - Tingting Pang
- Guangxi University of Chinese Medicine, Nanning, China
| | - Zikun Chen
- Guangxi University of Chinese Medicine, Nanning, China
| | - Jing Li
- Guangxi University of Chinese Medicine, Nanning, China
| | - Lin Wu
- Department of Neurology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, China
| | - Yuqiang Hu
- Department of Neurology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, China
| | - Wei Chen
- Department of Neurology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, China
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Sharma D, Spring KJ, Bhaskar SMM. Neutrophil-lymphocyte ratio in acute ischemic stroke: Immunopathology, management, and prognosis. Acta Neurol Scand 2021; 144:486-499. [PMID: 34190348 DOI: 10.1111/ane.13493] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/10/2021] [Accepted: 06/18/2021] [Indexed: 12/14/2022]
Abstract
There is an ongoing need for accurate prognostic biomarkers in the milieu of acute ischemic stroke (AIS) receiving reperfusion therapy. Neutrophil-lymphocyte ratio (NLR) has been implicated in emergency medicine and acute stroke setting as an important biomarker in the prognosis of patients. However, there are ongoing questions around its accuracy and translation into clinical practice given suboptimal sensitivity and specificity results, as well as varying thresholds and lack of clarity around which NLR time points are most clinically indicative. This article provides a comprehensive overview of the role of NLR in AIS patients receiving reperfusion therapy and perspectives on areas of future research. NLR may be an important biomarker in risk stratifying patients in AIS to identify and select those who are more likely to benefit from reperfusion therapy. Appropriate clinical decision-making tools and models are required to harness the predictive value of NLR, which could be useful in identifying and monitoring high-risk patients to guide early treatment and achieve improved outcomes. Our understanding of the role of NLR in the immunopathogenesis of AIS is also suboptimal, which hinders the ability to translate this into clinical practice.
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Affiliation(s)
- Divyansh Sharma
- Neurovascular Imaging Laboratory Clinical Sciences Stream Ingham Institute for Applied Medical Research Sydney NSW Australia
- South Western Sydney Clinical School University of New South Wales (UNSW) Sydney NSW Australia
| | - Kevin J. Spring
- South Western Sydney Clinical School University of New South Wales (UNSW) Sydney NSW Australia
- NSW Health Pathology NSW Brain Clot Bank Sydney NSW Australia
- Medical Oncology Group Liverpool Clinical School Western Sydney University & Ingham Institute of Applied Medical Research Sydney NSW Australia
| | - Sonu Menachem Maimonides Bhaskar
- Neurovascular Imaging Laboratory Clinical Sciences Stream Ingham Institute for Applied Medical Research Sydney NSW Australia
- NSW Health Pathology NSW Brain Clot Bank Sydney NSW Australia
- Department of Neurology & Neurophysiology Liverpool Hospital and South Western Sydney Local Health District (SWSLHD) Sydney NSW Australia
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10
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Zhang H, Wu T, Tian X, Lyu P, Wang J, Cao Y. High Neutrophil Percentage-To-Albumin Ratio Can Predict Occurrence of Stroke-Associated Infection. Front Neurol 2021; 12:705790. [PMID: 34566849 PMCID: PMC8455847 DOI: 10.3389/fneur.2021.705790] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/28/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: Stroke-associated infection (SAI) is associated with adverse outcomes in patients with acute ischemic stroke (AIS). In this study, we aimed to evaluate the association between neutrophil percentage-to-albumin ratio (NPAR) and SAI occurrence in patients with AIS. Methods: We retrospectively analyzed all AIS patients who were admitted to the Neurology ward of The Second Hospital of Tianjin Medical University from November 2018 to October 2020. The relationship between NPAR and SAI was analyzed by multivariable analysis. The receiver operating characteristic (ROC) curve was used to compare the predicted value of albumin, neutrophil percentage, neutrophil-to-lymphocyte ratio (NLR), and NPAR. Results: We included 379 AIS patients out of which 51 (13.5%) developed SAI. The NPAR was independently associated with increased risk of SAI adjusting for confounders [adjusted odds ratio (aOR) = 10.52; 95% confidence interval (CI), 3.33-33.28; P <0.001]. The optimal cutoff value of NPAR for predicting SAI incidence was 1.64, with sensitivity and specificity of 90.2 and 55.8%, respectively. The area under the curve (AUC) value of NPAR [0.771 (0.725-0.812)] was higher than that of albumin [0.640 (0.590-0.689)], neutrophil percentage [0.747 (0.700-0.790)], and NLR [0.736 (0.689-0.780)], though the statistical significance appeared only between NPAR and albumin. Conclusions: We demonstrated that a higher NPAR could predict the occurrence of SAI. Thus, NPAR might be a more effective biomarker to predict SAI compared with albumin, neutrophil percentage, and NLR.
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Affiliation(s)
- Haipeng Zhang
- Department of Clinical Laboratory, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Ti Wu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaolin Tian
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Panpan Lyu
- Department of Medical Laboratory, Clinical Medical College of Tianjin Medical University, Tianjin, China
| | - Jianfei Wang
- Department of Clinical Laboratory, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yang Cao
- Department of Clinical Laboratory, The Second Hospital of Tianjin Medical University, Tianjin, China
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Shi G, Chen W, Gong P, Wang M, Zhou J, Wang X, Guo M, Lu J, Li Y, Feng H, Fu X, Zhou R, Xue S. The Relationship Between Serum YKL-40 Levels on Admission and Stroke-Associated Pneumonia in Patients with Acute Ischemic Stroke. J Inflamm Res 2021; 14:4361-4369. [PMID: 34511972 PMCID: PMC8422031 DOI: 10.2147/jir.s329612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/26/2021] [Indexed: 11/23/2022] Open
Abstract
Background Stroke-associated pneumonia (SAP) is a standout complication after acute ischemic stroke (AIS), with a prevalence of 7–38%. The aim of this prospective study was to investigate the relationship between serum YKL-40 levels at admission and SAP. Methods Between August 2020 and February 2021, consecutive AIS patients from two centers were enrolled prospectively. Serum YKL-40 concentrations were measured via enzyme-linked immunosorbent assay. We performed logistic regression analyses to explore the relationship between YKL-40 and SAP. Receiver operating characteristic curve was also used to assess the predictive ability of YKL-40 in predicting SAP. Results Ultimately, a total of 511 AIS patients were recruited. Multivariate logistic regression analysis showed that YKL-40 was independently related to SAP, whether as a continuous variable or as quartiles (P=0.001). The area under curve of YKL-40 to predict SAP was 0.765. The optimal cutoff value of YKL-40 as a predictor of SAP was determined to be 206.4 ng/mL, where the sensitivity was 63.1% and the specificity was 82.0%. Conclusion Our study demonstrated that YKL-40 might be considered as a useful biomarker to predict SAP in AIS patients.
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Affiliation(s)
- Guomei Shi
- Department of Neurology, The Taixing People's Hospital, Taixing, Jiangsu, People's Republic of China.,Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China
| | - Wenxiu Chen
- Department of Critical Care Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Pengyu Gong
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Meng Wang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Junshan Zhou
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Xiaorong Wang
- Department of Neurology, The Taixing People's Hospital, Taixing, Jiangsu, People's Republic of China
| | - Minwang Guo
- Department of Neurology, The Taixing People's Hospital, Taixing, Jiangsu, People's Republic of China
| | - Jingye Lu
- Department of Neurology, The Taixing People's Hospital, Taixing, Jiangsu, People's Republic of China
| | - Yan Li
- Department of Neurology, The Taixing People's Hospital, Taixing, Jiangsu, People's Republic of China
| | - Hongxuan Feng
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China.,Department of Neurology, The Affiliated Suzhou Hospital of Nanjing Medical University (Suzhou Municipal Hospital), Suzhou, Jiangsu, People's Republic of China
| | - Xuetao Fu
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China.,Department of Neurology, Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu, People's Republic of China
| | - Rujuan Zhou
- Department of Neurology, The Taixing People's Hospital, Taixing, Jiangsu, People's Republic of China
| | - Shouru Xue
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China
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Ran J, Cui Y, Wang Y, Gu P. Relationship between fasting blood glucose and subsequent vascular events in Chinese patients with mild ischaemic stroke: a cohort study. J Int Med Res 2021; 49:3000605211019645. [PMID: 34044643 PMCID: PMC8165852 DOI: 10.1177/03000605211019645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective To characterise the relationship between fasting blood glucose (FBG) and the
incidence of subsequent vascular events (SVE) during the 6 months following
a mild ischaemic stroke (MIS) in Chinese patients. Methods Data from patients with MIS were retrospectively analysed. The primary
endpoint was an SVE during the 6-month follow-up period. The participants
were allocated to three groups (tertiles), according to their FBG
concentration. Results Of the 260 participants, 51 (19.6%) reported an SVE during the follow-up
period. The incidence of SVE significantly differed among the tertiles of
FBG. The odds ratio (OR) was 2.361 (95% confidence interval [CI]:
1.551–3.594) for FBG as a continuous variable and that for FBG categorised
according to tertile was 13.30 (95% CI: 3.519–50.322) in the fully adjusted
model. Curve fitting showed that the incidence of SVE gradually increased
with increasing FBG, with the highest tertile showing the highest mean
incidence (46.7%; 95% CI: 16.2%–79.9%). In addition, participants with or
without diabetes mellitus, hypertension, headache, dizziness, mild cognitive
impairment or anterior circulation artery lesion showed similar associations
between FBG and the incidence of SVE. Conclusion FBG is an independent predictor of 6-month SVE risk in Chinese patients with
MIS.
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Affiliation(s)
- Juanjuan Ran
- Department of Neurology, Wuxi No.5 People's Hospital, Wuxi, China
| | - Yu Cui
- Department of Neurology, Wuxi No.5 People's Hospital, Wuxi, China
| | - Yi Wang
- Department of Neurology, Wuxi No.5 People's Hospital, Wuxi, China
| | - Ping Gu
- Department of Neurology, Wuxi No.5 People's Hospital, Wuxi, China
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de Oliveira AJM, Solla DJF, de Oliveira KF, Amaral BS, Andrade AF, Kolias AG, Paiva WS. Postoperative neutrophil-to-lymphocyte ratio variation is associated with chronic subdural hematoma recurrence. Neurol Sci 2021; 43:427-434. [PMID: 33891187 DOI: 10.1007/s10072-021-05241-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 04/08/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Chronic subdural haematoma (CSDH) is one of the most common neurosurgical pathologies. The recurrence of chronic subdural haematomas is an important concern, considering that elderly patients are the most affected and reoperations in these patients may represent a risk of neurological and clinical complications. In accordance with the inflammatory theory regarding CSDH and its recurrence, we aimed to evaluate the role of an inflammatory marker, neutrophil-to-lymphocyte ratio (NLR), as a risk factor and prognostic variable for CSDH recurrence. METHODS We performed a cohort study of adult patients operated for post-traumatic CSDH traumatic CSDH between January 2015 and December 2019 in our neurotrauma unit, whose data was retrospectively retrieved. We excluded patients with previous inflammatory or infectious diseases as well as use of anticoagulant/antiplatelet medications. Neutrophil and lymphocyte counts were obtained 24 h preoperatively and 48-72 h postoperatively. The primary endpoint was symptomatic recurrence of CSDH up to 1 year after the surgery. An independent sample was used to validate the findings. RESULTS The testing sample comprised 160 patients (59.4% male, mean age 69.3 ± 14.3 years, recurrence rate 22.5%). Postoperative neutrophil count and NLR were higher in those who recurred, as well as the neutrophils (median 1.15 vs 0.96, p = 0.022) and NLR (median 1.29 vs 0.79, p = 0.001) postoperative-to-preoperative ratios. Preoperative laboratory parameters or other baseline variables were not associated with recurrence. Postoperative NLR ratio (each additional unit, OR 2.53, 95% CI 1.37-4.67, p = 0.003) was independently associated with recurrence. The best cut-off for the postoperative NLR ratio was 0.995 (AUC-ROC 0.67, sensitivity 63.9%, specificity 76.6%). Postoperative NLR ratio ≥ 1 (i.e. a post-operative NLR that does not decrease compared to the preoperative value) was associated with recurrence (OR 4.59, 95% CI 2.00-10.53, p < 0.001). The validation sample analysis (66 patients) yielded similar results (AUC-ROC 0.728, 95% CI 0.594-0.862, p = 0.002) and similar cut-off (≥ 1.05, sensitivity 77.8%, specificity 66.7%). CONCLUSION NLR ratio can be a useful parameter for the prediction of post-traumatic CSDH recurrence. This hypothesis was validated in an independent sample and the accuracy was moderate.
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Affiliation(s)
- Adilson J M de Oliveira
- Department of Neurology, Division of Neurosurgery, Neurotrauma Unit, Hospital das clinicas, University of São Paulo Medical School, São Paulo, Brazil.
- Neurocience centre, Clínica Girassol, Comandante Gika street, 225, CEP: 01419-000, Luanda, Angola.
| | - Davi J F Solla
- Department of Neurology, Division of Neurosurgery, Neurotrauma Unit, Hospital das clinicas, University of São Paulo Medical School, São Paulo, Brazil
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Klever F de Oliveira
- Department of Neurology, Division of Neurosurgery, Neurotrauma Unit, Hospital das clinicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Bruno S Amaral
- Department of Neurology, Division of Neurosurgery, Neurotrauma Unit, Hospital das clinicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Almir F Andrade
- Department of Neurology, Division of Neurosurgery, Neurotrauma Unit, Hospital das clinicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Angelos G Kolias
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Wellingson S Paiva
- Department of Neurology, Division of Neurosurgery, Neurotrauma Unit, Hospital das clinicas, University of São Paulo Medical School, São Paulo, Brazil
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
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