Mehta Vishal, Sharma Akhya, Jyoti Divya, Prabhakar Rathod, Kumar Ritesh, Guria Rishi T, Sharma Chandra B
Department of Medicine, Rajendra Institute of Medical Sciences, Ranchi, India.
Department of Internal Medicine, Loyola Medicine-MacNeal Hospital, Berwyn, IL, USA.
J Cent Nerv Syst Dis. 2023 Feb 7;15:11795735231156349. doi: 10.1177/11795735231156349. eCollection 2023.
Early neurological deterioration (END) is a common occurrence in ischemic stroke and contributes significantly to poor outcomes. Although multiple factors that predict END have already been identified, the role of fibrinogen - a key component of the coagulation pathway, is controversial.
To assess the role of fibrinogen in predicting END and poor hospital outcome in patients with acute ischemic stroke.
Single-centre prospective observational study.
141 patients with acute ischemic stroke were analyzed in this prospective observational study from a single tertiary-care hospital in East India. END was defined as a worsening of ≥2 points on the National Institutes of Health Stroke Scale (NIHSS) within 7 days of admission. A score of 3-5 on the Modified Rankin Scale (mRS), a stroke recurrence event or death during hospital stay was considered poor hospital outcome. We performed univariate analysis using age, sex, body-mass index (BMI), hypertension, diabetes, NIHSS scores, stroke etiology, blood glucose and lipid parameters and plasma fibrinogen to develop a logistic regression model to establish the independent predictors of END and poor outcome.
Age (Odds Ratio (OR) 1.034 [95% CI 1.001-1.069], = .046), NIHSS score at admission (OR 1.152 [95% CI 1.070-1.240], < .001) and fibrinogen (OR 1.011 [95%CI 1.006-1.015], < .001) were independent predictors of END in patients with acute ischemic stroke. Factors independently associated with poor outcome were NIHSS score at admission (OR 1.257 [95% CI 1.150-1.357], < .001), fasting plasma glucose (OR 1.007 [95% CI 1.001-1.013], = .020), and fibrinogen [OR 1.004 [95% CI 1.000-1.007], = .038).
The significant role of fibrinogen in determining neurological worsening and subsequent poor outcomes in patients with acute ischemic stroke may help in early prognostication and guided therapeutic interventions.
早期神经功能恶化（END）在缺血性卒中中很常见，并且对不良预后有显著影响。尽管已经确定了多种预测END的因素，但凝血途径的关键成分纤维蛋白原的作用仍存在争议。
评估纤维蛋白原在预测急性缺血性卒中患者END及不良住院结局中的作用。
单中心前瞻性观察性研究。
在印度东部一家三级医疗中心进行的这项前瞻性观察性研究中，分析了141例急性缺血性卒中患者。END定义为入院7天内美国国立卫生研究院卒中量表（NIHSS）评分恶化≥2分。改良Rankin量表（mRS）评分为3 - 5分、住院期间卒中复发事件或死亡被视为不良住院结局。我们使用年龄、性别、体重指数（BMI）、高血压、糖尿病、NIHSS评分、卒中病因、血糖和血脂参数以及血浆纤维蛋白原进行单因素分析，以建立逻辑回归模型，确定END和不良结局的独立预测因素。
年龄（比值比（OR）1.034 [95%置信区间（CI）1.001 - 1.069]，P = 0.046）、入院时NIHSS评分（OR 1.152 [95% CI 1.070 - 1.240]，P < 0.001）和纤维蛋白原（OR 1.011 [95% CI 1.006 - 1.015]，P < 0.001）是急性缺血性卒中患者END的独立预测因素。与不良结局独立相关的因素包括入院时NIHSS评分（OR 1.257 [95% CI 1.150 - 1.357]，P < 0.001）、空腹血糖（OR 1.007 [95% CI 1.001 - 1.013]，P = 0.020）和纤维蛋白原[OR 1.004 [95% CI 1.000 - 1.007]，P = 0.038]。
纤维蛋白原在急性缺血性卒中患者神经功能恶化及随后不良结局的决定中起重要作用，这可能有助于早期预后评估和指导治疗干预。
