Liu Chang, Zhang Yun, Niu Lingchuan, Li Jiani
Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Front Neurol. 2022 Jan 18;12:797394. doi: 10.3389/fneur.2021.797394. eCollection 2021.
We aim to investigate whether the higher admission fibrin degradation products (FDPs) levels are associated with parenchymal hematomas (PHs) and unfavorable outcome after intravenous thrombolysis (IVT).
Consecutive patients with acute ischemic stroke treated with IVT were studied. The FDP level was obtained on admission. PH was evaluated 24 h after treatment. The unfavorable outcome was defined as a 90-day modified Rankin Scale >2. The multivariable linear stepwise regression was used to assess independent factors associated with the log-transformed FDP (lgFDP). The receiver operating characteristics (ROCs) curve analysis was used to determine the predictive value of the FDP level for PH and unfavorable outcome. The logistic regression was used to identify independent predictors for PH and unfavorable outcome. The mediation analyses were performed to investigate associations among the FDP level, PH, and outcome.
A total of 181 patients were included in the final analyses [median age, 73 (63-79) years; 102 (56.4%) males; and the median baseline National Institutes of Health Stroke Scale (NIHSS) score, 8 (5-15)]. The lgFDP was independently associated with age ( = 0.011, 95% CI 0.006-0.015, < 0.001) and the baseline NIHSS score ( = 0.016, 95% CI 0.008-0.025, < 0.001). The FDP was positively associated with PH [odds ratio (OR) 1.034, 95% CI 1.000-1.069; = 0.047]. According to the ROC analysis, the best discriminating factor for unfavorable outcome was the FDP ≥3.085 μg/ml. The FDP ≥3.085 μg/ml was an independent predictor of unfavorable outcome (OR 7.086, 95% CI 2.818-17.822; < 0.001). Mediation analysis revealed that the association of the FDP ≥3.085 μg/ml with unfavorable outcome was not mediated by PH ( = 0.161).
The admission FDP levels can predict PH and unfavorable outcome in patients with acute ischemic stroke after IVT. PH does not mediate the effect of the FDP level on the outcome.
我们旨在研究静脉溶栓（IVT）后，较高的入院纤维蛋白降解产物（FDP）水平是否与脑实质血肿（PH）及不良预后相关。
对接受IVT治疗的急性缺血性卒中连续患者进行研究。入院时测定FDP水平。治疗24小时后评估PH情况。不良预后定义为90天改良Rankin量表评分>2分。采用多变量线性逐步回归分析评估与对数转换后的FDP（lgFDP）相关的独立因素。采用受试者工作特征（ROC）曲线分析确定FDP水平对PH及不良预后的预测价值。采用逻辑回归分析确定PH及不良预后的独立预测因素。进行中介分析以研究FDP水平、PH与预后之间的关联。
最终纳入181例患者[中位年龄73（63-79）岁；男性102例（56.4%）；基线美国国立卫生研究院卒中量表（NIHSS）评分中位数为8（5-15）分]。lgFDP与年龄独立相关（β = 0.011，95%CI 0.006-0.015，P < 0.001）及基线NIHSS评分独立相关（β = 0.016，95%CI 0.008-0.025，P < 0.001）。FDP与PH呈正相关[比值比（OR）1.034，95%CI 1.000-1.069；P = 0.047]。根据ROC分析，不良预后的最佳鉴别因素为FDP≥3.085μg/ml。FDP≥3.085μg/ml是不良预后的独立预测因素（OR 7.086，95%CI 2.818-17.822；P < 0.001）。中介分析显示，FDP≥3.085μg/ml与不良预后之间的关联并非由PH介导（P = 0.161）。
入院FDP水平可预测IVT后急性缺血性卒中患者的PH及不良预后。PH并未介导FDP水平对预后的影响。
