Guo Zhiliang, Hou Jie, Yu Shuai, Zhang Hang, Yu Shuhong, Wang Huaishun, Xu Jiaping, You Shoujiang, Huang Zhichao, Xiao Guodong, Cao Yongjun, Liu Chun-Feng
Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China.
Department of Encephalopathy, Suzhou Integrated Traditional Chinese and Western Medicine Hospital, Suzhou, China.
Front Aging Neurosci. 2022 May 23;14:830858. doi: 10.3389/fnagi.2022.830858. eCollection 2022.
Eosinophils contribute to antibacterial defense by releasing mitochondrial DNA, which are decreased in patients with acute ischemic stroke (AIS). However, the impact of eosinophils on stroke-associated pneumonia (SAP) among patients with AIS remains unclear. Moreover, whether SAP is in the path of the association between eosinophils and clinical outcomes also remains unclear. We aimed to assess the relationships between eosinophils, SAP, and clinical outcome after mechanical thrombectomy in patients with AIS.
A total of 328 consecutive patients with AIS who underwent mechanical thrombectomy between May 2017 and March 2021 were analyzed. Their baseline data and peripheral eosinophil counts were recorded on admission. Regression analysis was used to assess the effect of eosinophils on SAP, and its effect on poor outcome is defined as a modified Rankin Scale score of 3-6 at month 3 after admission. Mediation analysis was utilized to assess the proportion of the total effect of SAP on the association between eosinophils and poor outcomes.
Multivariate analysis revealed that eosinophils was independently associated with SAP after adjusting for potential confounders (odds ratio, 0.00; 95% CI, 0.00-0.38; = 0.0267), which are consistent with the result of eosinophils (dichotomous) as a categorical variable (odds ratio, 0.54; 95% CI, 0.31-0.96; = 0.0342). A non-linear relationship was detected between eosinophils and SAP, whose inflection point was 0.06. Subgroup analyses further confirmed these associations. Eosinophils were also associated with poor outcomes (odds ratio, 0.00; 95% CI, 0.00-0.14; = 0.0124). Additionally, mediation analysis found that SAP partially mediated the negative relationship between eosinophils and poor outcome (indirect effect = -0.169; 95% CI:-0.339 --0.040, < 0.001).
Our findings suggested that a lower eosinophil level was associated with higher SAP and poorer outcome, and SAP might play an important effect in the association between eosinophils and poor outcomes.
嗜酸性粒细胞通过释放线粒体DNA参与抗菌防御，而急性缺血性卒中（AIS）患者的嗜酸性粒细胞数量减少。然而，嗜酸性粒细胞对AIS患者卒中相关性肺炎（SAP）的影响尚不清楚。此外，SAP是否处于嗜酸性粒细胞与临床结局之间的关联路径中也不清楚。我们旨在评估AIS患者机械取栓术后嗜酸性粒细胞、SAP和临床结局之间的关系。
分析了2017年5月至2021年3月期间连续328例行机械取栓术的AIS患者。记录其入院时的基线数据和外周血嗜酸性粒细胞计数。采用回归分析评估嗜酸性粒细胞对SAP的影响，将其对不良结局的影响定义为入院后3个月改良Rankin量表评分为3 - 6分。采用中介分析评估SAP对嗜酸性粒细胞与不良结局之间关联的总效应比例。
多变量分析显示，在调整潜在混杂因素后，嗜酸性粒细胞与SAP独立相关（比值比，0.00；95%可信区间，0.00 - 0.38；P = 0.0267），这与将嗜酸性粒细胞（二分法）作为分类变量的结果一致（比值比，0.54；95%可信区间，0.31 - 0.96；P = 0.0342）。检测到嗜酸性粒细胞与SAP之间存在非线性关系，其拐点为0.06。亚组分析进一步证实了这些关联。嗜酸性粒细胞也与不良结局相关（比值比，0.00；95%可信区间，0.00 - 0.14；P = 0.0124）。此外，中介分析发现，SAP部分介导了嗜酸性粒细胞与不良结局之间的负相关关系（间接效应 = -0.169；95%可信区间：-0.339 --0.040，P < 0.001）。
我们的研究结果表明，较低的嗜酸性粒细胞水平与较高的SAP发生率和较差的结局相关，且SAP可能在嗜酸性粒细胞与不良结局之间的关联中起重要作用。
