Jin Huijuan, Bi Rentang, Hu Jichuan, Xu Da, Su Ying, Huang Ming, Peng Qiwei, Li Zhifang, Chen Shengcai, Hu Bo
Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Neurology, People's Hospital of Dongxihu District, Wuhan, China.
Front Neurol. 2022 Apr 6;13:816216. doi: 10.3389/fneur.2022.816216. eCollection 2022.
Currently, acute ischemic stroke (AIS) is one of the most common and serious diseases in the world and is associated with very high mortality and morbidity even after thrombolysis therapy. This study aims to research the relationship between lactic dehydrogenase (LDH) and prognosis in AIS patients treated with intravenous rtPA.
This study (a Multicenter Clinical Trial of Revascularization Treatment for Acute Ischemic Stroke, TRAIS) included 527 AIS patients in 5 cooperative medical institutions in China from January 2018 to February 2021. The primary outcome was major disability and death within 3 months (mRS score of 3-6), and the secondary outcomes were early neurological improvement (ENI), early neurological deterioration (END), moderate-severe cerebral edema (CE), and symptomatic intracranial hemorrhage (sICH).
The mean age of the 527 patients was 65.6 ± 11.7 years, and the median baseline NIHSS score was 4 (interquartile range, 2-7). The median serum LDH level was 184 U/L (interquartile range, 163-212 U/L). In total, 287 (54.5%) patients acquired ENI, 68 (13.0%) patients suffered END, 53 (12.1%) patients were observed with moderate-severe CE, and 28 (6.2%) patients showed sICH. Within 3 months, 127 (25.15%) patients experienced the primary outcome and 42 (8.3%) patients died. Serum LDH levels before thrombolysis showed an independent association with the risk of primary outcome [adjusted odds ratio, 3.787; (95% CI, 1.525-9.404); = 0.014]. When log-transformed LDH increased each standard deviation, the risk of primary outcome was raised by 80.1% (95% CI, 28.9-251.7%). A positive linear dependence between the risk of primary outcome and serum LDH levels ( of linearity = 0.0248, of non-linearity = 0.8284) was shown in multivariable-adjusted spline regression models. Pre-thrombolysis LDH quartile also provided a conventional risk model and significant improvement of the prediction for clinical outcomes, with a net reclassification improvement index (NRI) = 41.86% ( < 0.001) and integrated discrimination improvement (IDI) = 4.68% ( < 0.001).
Elevated serum LDH levels predicted unfavorable clinical outcomes after intravenous thrombolysis in AIS patients.
目前，急性缺血性卒中（AIS）是世界上最常见且严重的疾病之一，即便经过溶栓治疗，其死亡率和致残率仍很高。本研究旨在探讨静脉注射重组组织型纤溶酶原激活剂（rtPA）治疗的AIS患者中乳酸脱氢酶（LDH）与预后的关系。
本研究（急性缺血性卒中血管再通治疗多中心临床试验，TRAIS）纳入了2018年1月至2021年2月期间中国5家合作医疗机构的527例AIS患者。主要结局为3个月内的严重残疾和死亡（改良Rankin量表评分3 - 6分），次要结局为早期神经功能改善（ENI）、早期神经功能恶化（END）、中重度脑水肿（CE）和症状性颅内出血（sICH）。
527例患者的平均年龄为65.6±11.7岁，基线美国国立卫生研究院卒中量表（NIHSS）评分中位数为4分（四分位间距，2 - 7分）。血清LDH水平中位数为184 U/L（四分位间距，163 - 212 U/L）。共有287例（54.5%）患者获得ENI，68例（13.0%）患者发生END，53例（12.1%）患者出现中重度CE，28例（6.2%）患者发生sICH。3个月内，127例（25.15%）患者出现主要结局，42例（8.3%）患者死亡。溶栓前血清LDH水平与主要结局风险呈独立相关[校正比值比，3.787；（95%置信区间（CI），1.525 - 9.404）；P = 0.014]。当对数转换后的LDH每增加1个标准差，主要结局风险升高80.1%（95% CI，28.9 - 251.7%）。多变量调整样条回归模型显示主要结局风险与血清LDH水平呈正线性相关（线性P = 0.0248，非线性P = 0.8284）。溶栓前LDH四分位数也提供了一个传统风险模型，且显著改善了临床结局预测，净重新分类改善指数（NRI） = 41.86%（P < 0.001），综合判别改善（IDI） = 4.68%（P < 0.001）。
血清LDH水平升高预示AIS患者静脉溶栓后临床结局不佳。
