Department of Neurology, Taikang Xianlin Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210000, China.
Department of Stomatology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210000, China.
Aging Clin Exp Res. 2020 Dec;32(12):2667-2675. doi: 10.1007/s40520-020-01498-z. Epub 2020 Feb 18.
Cholinesterase as a sensitive biomarker for prognosis in a variety of conditions but it is rare in stroke studies. The very elderly (≥ 80 years of age) represent the most susceptible group of ischemic stroke. We aimed to determine whether admission serum cholinesterase concentration had any effect on clinical outcome in very elderly patients (individuals aged ≥ 80 years) with acute ischemic stroke.
A retrospective record review was conducted in two tertiary university hospitals. Elderly patients aged ≥ 80 years admitted with a diagnosis of acute ischemic stroke from January 1, 2014 to November 30, 2019, who had a cholinesterase concentration drawn, were included. The patients were grouped based on the inflection points of the locally weighted regression and smoothing scatterplot (LOESS) curve between cholinesterase levels and in-hospital mortality (study outcome) with lower concentration as reference group.
A total of 612 patients were admitted with a diagnosis of acute ischemic stroke, and 569 met the inclusion criteria. A threshold effect was identified using regression smoothing scatterplot (LOESS), with one cutoff point of 4.0 KU/L. There was a significant difference in-hospital mortality was observed (P < 0.001). After adjusted demographic and clinical features, the OR of cholinesterase for mortality was 0.43 (95% CI 0.34-0.54, P < 0.001), suggesting that lower admission cholinesterase level was an independent risk factors for all-cause mortality among patients with AIS.
We have demonstrated a significant association between admission cholinesterase concentration and in-hospital mortality in very elderly patients with AIS.
胆碱酯酶作为多种情况下预后的敏感生物标志物，但在中风研究中很少见。非常高龄（≥80 岁）人群是缺血性中风的最易感群体。我们旨在确定急性缺血性中风的非常高龄患者（≥80 岁）入院时血清胆碱酯酶浓度是否对临床结局有任何影响。
对两家三级大学医院进行了回顾性病历回顾。纳入 2014 年 1 月 1 日至 2019 年 11 月 30 日因急性缺血性中风入院且检测了胆碱酯酶浓度的≥80 岁的老年患者。根据胆碱酯酶水平与院内死亡率（研究结局）之间的局部加权回归和平滑散点图（LOESS）曲线的拐点将患者分为低浓度组和高浓度组，以低浓度组为参考组。
共有 612 例患者因急性缺血性中风入院，其中 569 例符合纳入标准。使用回归平滑散点图（LOESS）发现了一个阈值效应，截点为 4.0 KU/L。观察到院内死亡率存在显著差异（P<0.001）。在调整人口统计学和临床特征后，胆碱酯酶的死亡率比值比（OR）为 0.43（95%置信区间 0.34-0.54，P<0.001），表明入院时较低的胆碱酯酶水平是 AIS 患者全因死亡率的独立危险因素。
我们证明了非常高龄急性缺血性中风患者入院时的胆碱酯酶浓度与院内死亡率之间存在显著相关性。
