Xie Jiali, Zhu Yinmeng, Pang Chunyang, Gao Lingfei, Yu Huan, Lv Wenjing, Zhang Wanli, Deng Binbin
Department of Neurology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
First Clinical College of Wenzhou Medical University, Wenzhou, China.
Front Nutr. 2022 Aug 18;9:918553. doi: 10.3389/fnut.2022.918553. eCollection 2022.
Stroke, classified as cardioembolism and non-cardioembolism (non-CE), entails a large socioeconomic burden on the elderly. The morbidity and mortality of non-CE are high, whereas studies concerning prognostic factors impacting function outcome remain underdeveloped and understudied. Liver function parameters are convenient approaches to predicting prognosis in cardiovascular diseases, but their clinical significance has not been well characterized in stroke, especially in non-CE. In our study, a total of 576 patients with non-CE at 1 year of follow-up were enrolled in a cohort from a consecutive hospital-based stroke registry, with randomly 387 patients as the development cohort and 189 patients as the validation cohort. The univariate and multivariate analyses revealed the following novel findings: (i) The incidence of unfavorable functional outcomes after non-CE was significantly greater ( < 0.01) in patients with higher age, aspartate aminotransferase (AST), the National Institutes of Health Stroke Scale (NIHSS) score, and depressed total protein (TP); (ii) We established a novel model and nomogram to predict stroke prognosis, in addition to the known factors (age and the NIHSS score). The levels of AST and TP were independently correlated with the incidence of unfavorable outcomes [AST: odds ratio (OR) = 1.026, 95% CI (1.002-1.050); TP: OR = 0.944, 95% CI (0.899-0.991)]; (iii) The results persisted in further subgroup analysis stratified by age, gender, the NIHSS score, and other prespecified factors, especially in males 60 years or older. Overall, this study demonstrates that hepatic parameters (AST and TP) after non-CE are considered to be associated with functional outcomes at 1-year follow-up, especially in males aged ≥ 60 years.
中风分为心源性栓塞和非心源性栓塞（非CE），给老年人带来了巨大的社会经济负担。非CE的发病率和死亡率很高，而关于影响功能结局的预后因素的研究仍不充分且研究较少。肝功能参数是预测心血管疾病预后的便捷方法，但其在中风尤其是非CE中的临床意义尚未得到充分表征。在我们的研究中，共有576例非CE患者在1年随访期被纳入一个基于医院连续卒中登记的队列，随机将387例患者作为发展队列，189例患者作为验证队列。单因素和多因素分析揭示了以下新发现：（i）年龄较大、天冬氨酸转氨酶（AST）、美国国立卫生研究院卒中量表（NIHSS）评分较高以及总蛋白（TP）降低的非CE患者出现不良功能结局的发生率显著更高（<0.01）；（ii）除已知因素（年龄和NIHSS评分）外，我们建立了一个新模型和列线图来预测中风预后。AST和TP水平与不良结局的发生率独立相关[AST：比值比（OR）=1.026，95%置信区间（CI）（1.002 - 1.050）；TP：OR = 0.944，95% CI（0.899 - 0.991）]；（iii）在按年龄、性别、NIHSS评分和其他预先指定因素分层的进一步亚组分析中结果依然成立，尤其是在60岁及以上的男性中。总体而言，本研究表明非CE后的肝脏参数（AST和TP）被认为与1年随访时的功能结局相关，尤其是在年龄≥60岁的男性中。
