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Bucci T, Pastori D, Pignatelli P, Ntaios G, Abdul-Rahim AH, Violi F, Lip GY. Albumin Levels and Risk of Early Cardiovascular Complications After Ischemic Stroke: A Propensity-Matched Analysis of a Global Federated Health Network. Stroke 2024; 55:604-612. [PMID: 38323429 PMCID: PMC10896196 DOI: 10.1161/strokeaha.123.044248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 12/18/2023] [Accepted: 01/12/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND No studies have investigated the association between albumin levels and the risk of early cardiovascular complications in patients with ischemic stroke. METHODS Retrospective analysis with a federated research network (TriNetX) based on electronic medical records (International Classification of Diseases-Tenth Revision-Clinical Modification and logical observation identifiers names and codes) mainly reported between 2000 and 2023, from 80 health care organizations in the United States. Based on albumin levels measured at admission to the hospital, patients with ischemic stroke were categorized into 2 groups: (1) reduced (≤3.4 g/dL) and (2) normal (≥3.5 g/dL) albumin levels. The primary outcome was a composite of all-cause death, heart failure, atrial fibrillation, ventricular arrhythmias, myocardial infarction, and Takotsubo cardiomyopathy 30 days from the stroke. Secondary outcomes were the risk for each component of the primary outcome. Cox regression analyses were used to calculate hazard ratios (HRs) and 95% CIs following propensity score matching. RESULTS Overall, 320 111 patients with stroke had normal albumin levels (70.9±14.7 years; 48.9% females) and 183 729 (57.4%) had reduced albumin levels (72.9±14.3 years; 50.3% females). After propensity score matching, the primary outcomes occurred in 36.0% of patients with reduced and 26.1% with normal albumin levels (HR, 1.48 [95% CI, 1.46-1.50]). The higher risk in patients with reduced albumin levels was consistent also for all-cause death (HR, 2.77 [95% CI, 2.70-2.84]), heart failure (HR, 1.31 [95% CI, 1.29-1.34]), atrial fibrillation (HR, 1.11 [95% CI, 1.09-1.13]), ventricular arrhythmias (HR, 1.38 [95% CI, 1.30-1.46]), myocardial infarction (HR, 1.60 [95% CI, 1.54-1.65]), and Takotsubo cardiomyopathy (HR, 1.51 [95% CI, 1.26-1.82]). The association between albumin levels and the risk of cardiovascular events was independent of advanced age, sex, multimorbidity, and other causes of hypoalbuminemia. A progressively increased risk of adverse events was found in patients with mild and severe reduced compared to normal albumin levels. CONCLUSIONS Albumin levels are associated with the risk of early cardiovascular events and death in patients with ischemic stroke. The potential pathophysiological or therapeutic roles of albumin in patients with stroke warrant further investigation.
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Affiliation(s)
- Tommaso Bucci
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool and Heart and Chest Hospital, United Kingdom (T.B., D.P., A.H.A.-R., G.Y.H.L.)
- Department of General and Specialized Surgery, Sapienza University of Rome, Italy (T.B.)
| | - Daniele Pastori
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool and Heart and Chest Hospital, United Kingdom (T.B., D.P., A.H.A.-R., G.Y.H.L.)
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.P., P.P., F.V.)
| | - Pasquale Pignatelli
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.P., P.P., F.V.)
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece (G.N.)
| | - Azmil H. Abdul-Rahim
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool and Heart and Chest Hospital, United Kingdom (T.B., D.P., A.H.A.-R., G.Y.H.L.)
- Stroke Division, Department of Medicine for Older People, Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, United Kingdom (A.H.A.-R.)
| | - Francesco Violi
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Italy (D.P., P.P., F.V.)
| | - Gregory Y.H. Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool and Heart and Chest Hospital, United Kingdom (T.B., D.P., A.H.A.-R., G.Y.H.L.)
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Denmark (G.Y.H.L.)
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Yang D, Niu C, Li P, Du X, Zhao M, Jing W. Study of the neutrophil percentage-to-albumin ratio as a biomarker for predicting recurrence of first-episode ischemic stroke. J Stroke Cerebrovasc Dis 2024; 33:107485. [PMID: 37966092 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 10/19/2023] [Accepted: 11/09/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVE Neutrophils and albumin are associated with recurrence in patients with acute ischemic stroke. The purpose of this study was to evaluate the association between the neutrophil percentage-to-albumin ratio (NPAR) and recurrence in patients with first-episode acute ischemic stroke to identify a more predictive biomarker for ischemic stroke recurrence. METHODS In this study, the clinical data of patients with first-episode acute ischemic stroke admitted to the Department of Neurology of Shanxi Bethune Hospital from June 2021 to June 2022 were retrospectively collected, and a total of 829 patients who met the inclusion and exclusion criteria were followed up for 3 months. We evaluated the recurrence of patients within 3 months after acute ischemic stroke. Univariable and multivariable analyses were performed to determine the relationship between the NPAR and recurrence within 3 months in patients with AIS. Finally, ROC curves were used to compare the predicted values of albumin, neutrophil percentage, the neutrophil-to-lymphocyte ratio, and the NPAR. RESULTS A total of 829 first-episode acute ischemic stroke patients were included. The median NPAR was 1.60 (IQR 1.44-1.79). The percentage of patients with a 3-month recurrence was 6.0 % (50/829). The multivariate analysis showed that the NPAR was independently associated with the risk of recurrence within 3 months in acute ischemic stroke (OR 9.71, 95 % CI: 3.05-31.62, P < 0.001). The optimal cutoff value of the NPAR for predicting recurrence of acute ischemic stroke within 3 months was 1.78, with a sensitivity of 0.80 and a specificity of 0.75. Compared with the NLR, albumin and neutrophil percentage, the NPAR showed the greatest area under the curve (AUC) [0.78 (0.73, 0.83)]. The AUC test showed that the difference in the NPAR and neutrophil-to-lymphocyte ratio (P = 0.019), NPAR and albumin (P = 0.013), and NPAR and neutrophil percentage (P = 0.007) were statistically significant, while the difference between the other two were not statistically significant (P > 0.05). CONCLUSION 1. The recurrence rate within 3 months among patients with a first episode of acute ischemic stroke was 6.0 %.2. The NPAR was independently associated with recurrence within 3 months among patients with a first episode of acute ischemic stroke. Moreover, the NPAR may be a more effective biomarker for predicting recurrence in acute ischemic stroke patients than the albumin level, neutrophil percentage, and neutrophil-to-lymphocyte ratio.
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Affiliation(s)
- Debo Yang
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan,030032,China
| | - Cailang Niu
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan,030032,China
| | - Penghong Li
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan,030032,China
| | - Xueqing Du
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan,030032,China
| | - Mina Zhao
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan,030032,China
| | - Wei Jing
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan,030032,China.
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Liu M, Sun M, Zhang T, Li P, Liu J, Liu Y, Song Y, Liu S, Yang H, Zhou Z, Chang D, Wang G, Mi W, Ma Y. Prognostic Nutritional Index (PNI) as a potential predictor and intervention target for perioperative ischemic stroke: a retrospective cohort study. BMC Anesthesiol 2023; 23:268. [PMID: 37563630 PMCID: PMC10413636 DOI: 10.1186/s12871-023-02216-8] [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: 04/03/2023] [Accepted: 07/20/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND The prognostic nutritional index (PNI) is a nutritional indicator and predictor of various diseases. However it is unclear whether PNI can be a predictor of perioperative ischemic stroke. This study aims to evaluate the association of the preoperative PNI and ischemic stroke in patients undergoing non-cardiac surgery. METHODS The retrospective cohort study included patients who underwent noncardiac surgery between January 2008 and August 2019. The patients were divided into PNI ≥ 38.8 and PNI < 38.8 groups according to the cut-off value of PNI. Univariate and multivariate logistic regression analyses were performed to explore the association between PNI and perioperative ischemic stroke. Subsequently, propensity score matching (PSM) analysis was performed to eliminate the confounding factors of covariates and further validate the results. Subgroup analyses were completed to assess the predictive utility of PNI for perioperative ischemic stroke in different groups. RESULTS Amongst 221,542 hospitalized patients enrolled, 485 (0.22%) experienced an ischemic stroke within 30 days of the surgery, 22.1% of patients were malnourished according to PNI < 38.8, and the occurrence of perioperative ischemic stroke was 0.34% (169/49055) in the PNI < 38.8 group. PNI < 38.8 was significantly associated with an increased incidence of perioperative ischemic stroke whether in univariate logistic regression analysis (OR = 1.884, 95% CI: 1.559-2.267, P < 0.001) or multivariate logistic regression analysis (OR = 1.306, 95% CI: 1.061-1.602, P = 0.011). After PSM analysis, the ORs of PNI < 38.8 group were 1.250 (95% CI: 1.000-1.556, P = 0.050) and 1.357 (95% CI: 1.077-1.704, P = 0.009) in univariate logistic regression analysis and multivariate logistic regression analysis respectively. The subgroup analysis indicated that reduced PNI was significantly associated to an increased risk of perioperative ischemic stroke in patients over 65 years old, ASA II, not taking aspirin before surgery, without a history of stroke, who had neurosurgery, non-emergency surgery, and were admitted to ICU after surgery. CONCLUSIONS Our study indicates that low preoperative PNI is significantly associated with a higher incidence of ischemic stroke in patients undergoing non-cardiac surgery. Preoperative PNI, as a preoperative nutritional status evaluation index, is an independent risk factor useful to predict perioperative ischemic stroke risk, which could be used as an intervenable preoperative clinical biochemical index to reduce the incidence of perioperative ischemic stroke.
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Affiliation(s)
- Min Liu
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
- Nation Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, 100730, China
| | - Miao Sun
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
- Department of Anesthesiology, The First Affiliated Hospital, Jinzhou Medical University, Jinzhou, 121000, China
| | - Ting Zhang
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Peng Li
- Department of Anesthesiology, The Sixth Medical Center of PLA General Hospital, Beijing , 100048, China
| | - Jin Liu
- Hangzhou Le9 Healthcare Technology Co., Ltd, Hangzhou, 311200, China
| | - Yanhong Liu
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Yuxiang Song
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Siyuan Liu
- Department of Anesthesiology, Affiliated Hospital of Nantong University, Nantong, 226001, China
| | - Huikai Yang
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Zhikang Zhou
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Dandan Chang
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China
| | - Guyan Wang
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
| | - Weidong Mi
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China.
- Nation Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, 100730, China.
| | - Yulong Ma
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, China.
- Nation Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, 100730, China.
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Weng Y, Peng Y, Xu Y, Wang L, Wu B, Xiang H, Ji K, Guan X. The Ratio of Red Blood Cell Distribution Width to Albumin Is Correlated With All-Cause Mortality of Patients After Percutaneous Coronary Intervention – A Retrospective Cohort Study. Front Cardiovasc Med 2022; 9:869816. [PMID: 35686040 PMCID: PMC9170887 DOI: 10.3389/fcvm.2022.869816] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 04/14/2022] [Indexed: 12/14/2022] Open
Abstract
Objectives The purpose of this study was to investigate the independent effect of the ratio of red blood cell distribution width (RDW) to albumin (RA) on all-cause mortality in patients after percutaneous coronary intervention (PCI). Methods Clinical data were obtained from the Multiparameter Intelligent Monitoring in Intensive Care-III (MIMIC-III) database version 1.4 and the database of Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University. We used the MIMIC-III database for model training, and data collected from the Second Affiliated Hospital of Wenzhou Medical University for validation. The primary outcome of our study was 90-day mortality. Cox proportional hazards regression model was used to estimate hazard ratio (HR) for the association between RA and all-cause mortality in patients after PCI. Pearson correlation analysis was conducted to assess the relationship between RA and Gensini score or cardiac troponin I (cTnI). Results A total of 707 patients were eligible in MIMIC-III database, including 432 males, with a mean age of 70.29 years. For 90-day all-cause mortality, in the adjusted multivariable model, the adjusted HRs [95% confidence intervals (CIs)] for the second (RA: 3.7–4.5 ml/g) and third (RA >4.5 ml/g) tertiles were 2.27 (1.11, 4.64) and 3.67 (1.82, 7.40), respectively, compared to the reference group (RA <3.7 ml/g) (p < 0.05). A similar relationship was also observed for 30-day all-cause mortality and 1-year all-cause mortality. No significant interaction was observed in subgroup analysis. Receiver operating characteristic (ROC) curve analysis proved that the ability of RA to predict the 90-day mortality was better than that of RDW or albumin alone. The correlation coefficient between Gensini score and RA was 0.254, and that between cTnI and RA was 0.323. Conclusion RA is an independent risk factor for all-cause mortality in patients after PCI. The higher the RA, the higher the mortality. RA has a good predictive ability for all-cause mortality in patients after PCI, which is better than RDW or albumin alone. RA may be positively correlated with the severity of coronary artery disease (CAD) in patients with CAD.
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Qu S, Zhou M, Jiao S, Zhang Z, Xue K, Long J, Zha F, Chen Y, Li J, Yang Q, Wang Y. Optimizing acute stroke outcome prediction models: Comparison of generalized regression neural networks and logistic regressions. PLoS One 2022; 17:e0267747. [PMID: 35544482 PMCID: PMC9094516 DOI: 10.1371/journal.pone.0267747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 04/16/2022] [Indexed: 11/18/2022] Open
Abstract
Background Generalized regression neural network (GRNN) and logistic regression (LR) are extensively used in the medical field; however, the better model for predicting stroke outcome has not been established. The primary goal of this study was to compare the accuracies of GRNN and LR models to identify the most optimal model for the prediction of acute stroke outcome, as well as explore useful biomarkers for predicting the prognosis of acute stroke patients. Method In a single-center study, 216 (80% for the training set and 20% for the test set) acute stroke patients admitted to the Shenzhen Second People’s Hospital between December 2019 to June 2021 were retrospectively recruited. The functional outcomes of the patients were measured using Barthel Index (BI) on discharge. A training set was used to optimize the GRNN and LR models. The test set was utilized to validate and compare the performances of GRNN and LR in predicting acute stroke outcome based on the area under the receiver operating characteristic curve (AUROC), accuracy, sensitivity, and the Kappa value. Result The LR analysis showed that age, the National Institute Health Stroke Scale score, BI index, hemoglobin, and albumin were independently associated with stroke outcome. After validating in test set using these variables, we found that the GRNN model showed a better performance based on AUROC (0.931 vs 0.702), sensitivity (0.933 vs 0.700), specificity (0.889 vs 0.722), accuracy (0.896 vs 0.729), and the Kappa value (0.775 vs 0.416) than the LR model. Conclusion Overall, the GRNN model demonstrated superior performance to the LR model in predicting the prognosis of acute stroke patients. In addition to its advantage in not affected by implicit interactions and complex relationship in the data. Thus, we suggested that GRNN could be served as the optimal statistical model for acute stroke outcome prediction. Simultaneously, prospective validation based on more variables of the GRNN model for the prediction is required in future studies.
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Affiliation(s)
- Sheng Qu
- Department of Rehabilitation, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University Health Science Centre, Shenzhen, China
| | - Mingchao Zhou
- Department of Rehabilitation, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University Health Science Centre, Shenzhen, China
| | - Shengxiu Jiao
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong, China
| | - Zeyu Zhang
- School of Rehabilitation Sciences, The Shandong University of Traditional Chinese Medicine, Shandong, China
| | - Kaiwen Xue
- School of Rehabilitation Sciences, The Shandong University of Traditional Chinese Medicine, Shandong, China
| | - Jianjun Long
- Department of Rehabilitation, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University Health Science Centre, Shenzhen, China
- School of Rehabilitation Sciences, The Shandong University of Traditional Chinese Medicine, Shandong, China
| | - Fubing Zha
- Department of Rehabilitation, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University Health Science Centre, Shenzhen, China
| | - Yuan Chen
- Department of Rehabilitation, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University Health Science Centre, Shenzhen, China
| | - Jiehui Li
- School of Rehabilitation Sciences, The Shandong University of Traditional Chinese Medicine, Shandong, China
| | - Qingqing Yang
- School of Rehabilitation Sciences, The Shandong University of Traditional Chinese Medicine, Shandong, China
| | - Yulong Wang
- Department of Rehabilitation, Shenzhen Second People’s Hospital, The First Affiliated Hospital of Shenzhen University Health Science Centre, Shenzhen, China
- School of Rehabilitation Sciences, The Shandong University of Traditional Chinese Medicine, Shandong, China
- * E-mail:
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Lin G, Hu M, Song J, Xu X, Liu H, Qiu L, Zhu H, Xu M, Geng D, Yang L, Huang G, He J, Wang Z. High Fibrinogen to Albumin Ratio: A Novel Marker for Risk of Stroke-Associated Pneumonia? Front Neurol 2022; 12:747118. [PMID: 35095715 PMCID: PMC8792987 DOI: 10.3389/fneur.2021.747118] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/14/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Stroke-associated pneumonia (SAP) is associated with poor prognosis after acute ischemic stroke (AIS). Purpose: This study aimed to describe the parameters of coagulation function and evaluate the association between the fibrinogen-to-albumin ratio (FAR) and SAP in patients with AIS. Patients and methods: A total of 932 consecutive patients with AIS were included. Coagulation parameters were measured at admission. All patients were classified into two groups according to the optimal cutoff FAR point at which the sum of the specificity and sensitivity was highest. Propensity score matching (PSM) was performed to balance potential confounding factors. Univariate and multivariate logistic regression analyses were applied to identify predictors of SAP. Results: A total of 100 (10.7%) patients were diagnosed with SAP. The data showed that fibrinogen, FAR, and D-dimer, prothrombin time (PT), activated partial thromboplastin time (aPTT) were higher in patients with SAP, while albumin was much lower. Patients with SAP showed a significantly increased FAR when compared with non-SAP (P < 0.001). Patients were assigned to groups of high FAR (≥0.0977) and low FAR (<0.0977) based on the optimal cut-off value. Propensity score matching analysis further confirmed the association between FAR and SAP. After adjusting for confounding and risk factors, multivariate regression analysis showed that the high FAR (≥0.0977) was an independent variable predicting the occurrence of SAP (odds ratio =2.830, 95% CI = 1.654–4.840, P < 0.001). In addition, the FAR was higher in the severe pneumonia group when it was assessed by pneumonia severity index (P = 0.008). Conclusions: High FAR is an independent potential risk factor of SAP, which can help clinicians identify high-risk patients with SAP after AIS.
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Affiliation(s)
- Gangqiang Lin
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Minlei Hu
- Department of Neurology, The First Hospital of Jiaxing, Jiaxing, China
| | - Jiaying Song
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Xueqian Xu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Haiwei Liu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Linan Qiu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hanyu Zhu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Minjie Xu
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Dandan Geng
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Lexuan Yang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Guiqian Huang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- *Correspondence: Guiqian Huang
| | - Jincai He
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Jincai He
| | - Zhen Wang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Zhen Wang
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Chen C, Qiao X, Guo J, Yang T, Wang M, Ma Y, Zhao S, Ding L, Liu H, Wang J. Related factors based on non-targeted metabolomics methods in minor ischaemic stroke. Front Endocrinol (Lausanne) 2022; 13:952918. [PMID: 36237188 PMCID: PMC9552842 DOI: 10.3389/fendo.2022.952918] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study aimed to identify potential biomarkers associated with the occurrence of minor ischaemic stroke. METHODS Four hundred patients hospitalized with minor ischaemic stroke were enrolled in the department of neurological internal medicine in Taiyuan Central Hospital, and 210 healthy subjects examined at the Taiyuan Central Hospital Medical Center during the same period were selected. We collected information on the general demographic characteristics and fasting blood samples of the subjects. We then used untargeted metabolomic assay to measure blood glucose, blood lipids, homocysteine, and high-sensitivity C-reactive protein. RESULTS There were statistically significant differences between the mild ischemic stroke group and the healthy control group in smoking, hypertension, and physical activity (P< 0.05). Compared with the healthy group, the minor ischaemic stroke group showed increased lactate, pyruvate, trimetlylamine oxide levels, and lactic acid, pyruvic acid, and trimethylamine N-oxidation (TMAO) levels were statistically significant (P< 0.001). In the minor ischaemic stroke risk model, hypertension, physical activity, smoking, and elevated TMAO levels influenced the occurrence of minor stroke. CONCLUSION Increased levels of lactic acid, pyruvate, and TMAO may be related to the pathophysiological changes in the minor ischaemic stroke population. High blood pressure, a lack of physical activity, smoking, and increased TMAO level were the influencing factors for the occurrence of minor ischaemic stroke. The serum metabolite TMAO may be associated with MS occurrence.
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Affiliation(s)
- Chen Chen
- Shanxi Cardiovascular Hospital/Cardiovascular Hospital Affiliated to Shanxi Medical University, Taiyuan, China
- *Correspondence: Chen Chen, ; Jintao Wang,
| | - Xiaoyuan Qiao
- Shanxi Province Cancer Hospital/ Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, China
| | - Jianyong Guo
- Shanxi Cardiovascular Hospital/Cardiovascular Hospital Affiliated to Shanxi Medical University, Taiyuan, China
| | - Ting Yang
- Shanxi Cardiovascular Hospital/Cardiovascular Hospital Affiliated to Shanxi Medical University, Taiyuan, China
| | - Min Wang
- Shanxi Cardiovascular Hospital/Cardiovascular Hospital Affiliated to Shanxi Medical University, Taiyuan, China
| | - Yipeng Ma
- Shanxi Cardiovascular Hospital/Cardiovascular Hospital Affiliated to Shanxi Medical University, Taiyuan, China
| | - Shuhe Zhao
- Neurology Department, Taiyuan Central Hospital, Taiyuan, China
| | - Ling Ding
- Department of Epidemiology, Shanxi Medical University, Taiyuan, China
| | - Hong Liu
- Shanxi Cardiovascular Hospital/Cardiovascular Hospital Affiliated to Shanxi Medical University, Taiyuan, China
| | - Jintao Wang
- Department of Epidemiology, Shanxi Medical University, Taiyuan, China
- *Correspondence: Chen Chen, ; Jintao Wang,
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Fu K, Garvan CS, Heaton SC, Nagaraja N, Doré S. Association of Serum Bilirubin with the Severity and Outcomes of Intracerebral Hemorrhages. Antioxidants (Basel) 2021; 10:antiox10091346. [PMID: 34572977 PMCID: PMC8465680 DOI: 10.3390/antiox10091346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/19/2021] [Accepted: 08/19/2021] [Indexed: 11/22/2022] Open
Abstract
Intracerebral hemorrhage (ICH) is the second most common subtype of stroke, and it is often associated with a high mortality rate and significant morbidity among survivors. Recent studies have shown that bilirubin, a product of heme metabolism, can exhibit cytoprotective, antioxidant and, anti-inflammatory properties. However, little is known about the role of bilirubin in combating several pathophysiological pathways caused by intracerebral bleeding in patients with ICH. In this study, data were collected retrospectively on 276 patients with ICH who were admitted to a university hospital between 5 January 2014 and 31 December 2017. We assessed the relationship between levels of total, direct, and indirect serum bilirubin and assessments of initial stroke severity and clinical outcomes by using Spearman’s rank correlation and Kruskal-Wallis H tests. A secondary examination of the carrier protein albumin was also undertaken. Our study found that higher levels of direct bilirubin were correlated with worse admission Glasgow Coma Scales (GCS) (rs = −0.17, p = 0.011), worse admission ICH Scores (rs = 0.19, p = 0.008), and worse discharge modified Rankin Scales (mRS) (rs = 0.15, p = 0.045). Direct bilirubin was still significantly correlated with discharge mRS after adjusting for temperature at admission (rs = 0.16, p = 0.047), oxygen saturation at admission (rs = 0.15, p = 0.048), white blood cell count (rs = 0.18, p = 0.023), or Troponin T (rs = 0.25, p = 0.001) using partial Spearman’s correlation. No statistical significance was found between levels of total or indirect bilirubin and assessments of stroke severity and outcomes. In contrast, higher levels of albumin were correlated with better admission GCS (rs = 0.13, p = 0.027), discharge GCS (rs = 0.15, p = 0.013), and discharge mRS (rs = −0.16, p = 0.023). We found that levels of total bilirubin, direct bilirubin, and albumin were all significantly related to discharge outcomes classified by discharge destinations (p = 0.036, p = 0.014, p = 0.016, respectively; Kruskal-Wallis H tests). In conclusion, higher direct bilirubin levels were associated with greater stroke severity at presentation and worse outcomes at discharge among patients with ICH. Higher levels of albumin were associated with lower stroke severity and better clinical outcomes. Future prospective studies on the free bioactive bilirubin are needed to better understand the intricate relationships between bilirubin and ICH.
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Affiliation(s)
- Kai Fu
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL 32610, USA; (K.F.); (C.S.G.)
| | - Cynthia S. Garvan
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL 32610, USA; (K.F.); (C.S.G.)
| | - Shelley C. Heaton
- Department of Clinical & Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, FL 32610, USA;
| | - Nandakumar Nagaraja
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL 32610, USA;
| | - Sylvain Doré
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL 32610, USA; (K.F.); (C.S.G.)
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL 32610, USA;
- Center for Translational Research in Neurodegenerative Disease, Departments of Psychiatry, Pharmaceutics, and Neuroscience, McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL 32610, USA
- Correspondence: ; Tel.: +1-352-273-9663
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Zhou H, Wang A, Meng X, Lin J, Jiang Y, Jing J, Zuo Y, Wang Y, Zhao X, Li H, Wang Y. Low serum albumin levels predict poor outcome in patients with acute ischaemic stroke or transient ischaemic attack. Stroke Vasc Neurol 2021; 6:458-466. [PMID: 33632730 PMCID: PMC8485231 DOI: 10.1136/svn-2020-000676] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 01/06/2021] [Accepted: 01/24/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND To examine the relationship of serum albumin with poor functional outcome and mortality in patients with acute ischaemic stroke (AIS) or transient ischaemic attack (TIA), and perform a meta-analysis to summarise the association. METHODS We analysed data from the Third China National Stroke Registry (CNSR-Ⅲ). Patients were divided into four groups based on serum albumin levels at admission. The outcomes included poor functional outcome (modified Rankin Scale (mRS) score of 3 to 6) and mortality at 3 months and 1 year. Multiple logistic regression models and Cox regression models were used to evaluate the association, respectively. We used a fixed-effect model to calculate the risk ratio for poor functional outcome and a random-effect model for mortality in the meta-analysis. RESULTS A total of 13 618 patients were enrolled. During the 3-month follow-up period, compared with 40 to 44.9 g/L group, patients in <35 g/L group had an increased risk of poor functional outcome and mortality (adjusted OR 1.37 (95% CI 1.12 to 1.67); adjusted HR 2.13 (95% CI 1.41 to 3.23)). The relationship in per 10 g/L decreased serum albumin with prognosis was consistently inversed (adjusted OR 1.17 (95% CI 1.01 to 1.35); adjusted HR 1.86 (95% CI 1.30 to 2.64)). Also, low serum albumin levels were independently correlated with clinical outcomes at 1 year. In the meta-analysis, the OR for poor functional outcome pooled 3 studies per 1 g/L decrease was 1.03 (95% CI 1.02 to 1.05), and the HR for mortality pooled 5 studies was 1.07 (95% CI 1.03 to 1.11). CONCLUSIONS Low serum albumin levels predict poor functional outcome and mortality in patients with AIS or TIA.
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Affiliation(s)
- Hongyu Zhou
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jinxi Lin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yong Jiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Tiantan Neuroimaging Center of Excellence, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yingting Zuo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China .,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
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Adias TC, Erhabor O, Shehu SA, Erhabor T. Menstrual cycle-associated effects on some acute phase reactants parameters of Students in Usmanu Danfodiyo University Sokoto, North Western Nigeria. Hum Antibodies 2019; 27:291-298. [PMID: 31156156 DOI: 10.3233/hab-190386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The menstrual cycle is the cycle of natural variations that occurs in the uterus and ovary as an essential part of making sexual reproduction possible. It is characterized by hormonal changes but the changes that occur in some active phase reactants (APR) parameters have not been fully elucidated. OBJECTIVE The aim of this study was to compare the serum albumin, ESR, and C-reactive protein levels in follicular and luteal phases of menstruation. METHODS A total of 90 healthy regularly menstruating women where used for this study. Forty-five of the study participants were in their follicular phase while the other 45 where in their luteal phase. Four milliliters of blood were withdrawn from each patient under aseptic condition and two milliliters was dispensed into EDTA container while the other two milliliters were dispensed into a plane container. The EDTA anticoagulated blood was used for ESR and full blood count while the serum from the plain tubes was used for analysis of C-reactive protein and Serum Albumin. Sysmex K-3 auto-analyser (Sysmex, Kobe Japan) was used for te determination of full blood count, the Westergren method was used for ESR estimation, Bromo Cresyl Green method was used for serum albumin and ELISA method was used for CRP determination. Data analysis was carried out using SPSS version 23. RESULTS This study showed a statistically significant difference in the ESR (p= 0.03) among menstruating women in the follicular and luteal phases of menstruation. Sociodemographic factors had no statistically significant effect on the APR parameters of menstruating women in the follicular and luteal phases of menstruation (p> 0.05). There were no statistically significant differences between acute phase proteins of menstruating women in the follicular phase and luteal phases (p> 0.05). Also, age and marital status did not affect the acute phase proteins among menstruating women in the follicular phase and luteal phases (p> 0.05). CONCLUSIONS There is need to generate data on menstrual disorders and their impact on women's health status, quality of life and social integration. It is vital that evaluation and treatment of menstrual complaints should be given a higher priority in primary care programs. There is need to invest in public enlightenment program to increase awareness in secondary schools to increase the level of awareness among adolescents as well as young females.
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Affiliation(s)
- Teddy Charles Adias
- Department of Haematology, School of Medical Laboratory Science, Usmanu Danfodiyo University, Sokoto, Nigeria
| | - Osaro Erhabor
- Department of Haematology, School of Medical Laboratory Science, Usmanu Danfodiyo University, Sokoto, Nigeria
| | - Shafa'atu Abdullahi Shehu
- Department of Haematology, School of Medical Laboratory Science, Usmanu Danfodiyo University, Sokoto, Nigeria
| | - Tosan Erhabor
- Medical Laboratory Science Council of Nigeria, Nigeria
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Can demographic and admission laboratory variables be useful to identify long-stay patients with acute ischemic stroke? A hospital-based cohort study in Singapore. Neurol Sci 2009; 30:275-80. [DOI: 10.1007/s10072-009-0084-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Accepted: 03/30/2009] [Indexed: 10/20/2022]
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