C反应蛋白与白蛋白的高比值与急性缺血性卒中患者溶栓后出血性转化及功能预后不良相关。
High ratio of C-reactive protein to albumin is associated with hemorrhagic transformation and poor functional outcomes in acute ischemic stroke patients after thrombolysis.
作者信息
Xu Tong, Xia Lingfan, Wu Yucong, Xu Ye, Xu Xuan, Zhang Wangyu, Zhou Congcong, Fu Fangwang, Cao Yungang, Han Zhao
机构信息
Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
出版信息
Front Aging Neurosci. 2023 Feb 16;15:1109144. doi: 10.3389/fnagi.2023.1109144. eCollection 2023.
BACKGROUND
In patients with acute ischemic stroke, hemorrhagic transformation (HT) is a common complication after intravenous thrombolysis (IVT). In this study, we evaluated the relationship between the ratio of C-reactive protein to albumin (CAR) before thrombolysis, HT, and functional outcomes in patients with acute ischemic stroke.
METHODS
We retrospectively analyzed data from 354 patients who received thrombolytic therapy at the Second Affiliated Hospital of the Wenzhou Medical University in China between July 2014 and May 2022. CAR was measured on admission, and HT was identified by cranial computed tomography (CT) within 24-36 h after treatment. Poor outcome was defined as a score on the modified Rankin Scale (mRS) > 2 at discharge. The multivariate logistic regression model was used to investigate the association between CAR, HT, and poor outcome after thrombolysis, respectively.
RESULTS
A total of 354 patients were analyzed, and their median CAR was 0.61 (interquartile range, 0.24-1.28). CAR was significantly higher in the 56 patients (15.8%) who experienced HT than in those who did not (0.94 vs. 0.56, < 0.001), and the 131 patients (37.0%) who experienced poor outcome than in those who did not (0.87 vs. 0.43, < 0.001). Multivariate logistic regression indicated that CAR was an independent risk factor for both HT and poor outcome. The risk of HT was significantly higher among patients whose CAR fell in the fourth quartile than among those with CAR in the first quartile (OR 6.64, 95% CI 1.83 to 24.17, = 0.004). Patients with CAR in the third quartile were more likely to experience poor outcome (OR 3.35, 95% CI 1.32 to 8.51, = 0.01), as were those in the fourth quartile (OR 7.33, 95% CI 2.62 to 20.50, < 0.001), compared to patients with CAR in the first quartile.
CONCLUSION
High ratio of C-reactive protein to albumin in individuals with ischemic stroke is associated with an increased risk of HT and poor functional outcomes after thrombolysis.
背景
在急性缺血性卒中患者中，出血性转化（HT）是静脉溶栓（IVT）后常见的并发症。在本研究中，我们评估了急性缺血性卒中患者溶栓前C反应蛋白与白蛋白比值（CAR）、HT及功能结局之间的关系。
方法
我们回顾性分析了2014年7月至2022年5月在中国温州医科大学附属第二医院接受溶栓治疗的354例患者的数据。入院时测量CAR，并在治疗后24 - 36小时内通过头颅计算机断层扫描（CT）确定HT。不良结局定义为出院时改良Rankin量表（mRS）评分>2分。采用多因素logistic回归模型分别研究CAR、HT与溶栓后不良结局之间的关联。
结果
共分析了354例患者，其CAR中位数为0.61（四分位数间距，0.24 - 1.28）。发生HT的56例患者（15.8%）的CAR显著高于未发生HT的患者（0.94对0.56，<0.001），发生不良结局的131例患者（37.0%）的CAR显著高于未发生不良结局的患者（0.87对0.43，<0.001）。多因素logistic回归表明，CAR是HT和不良结局的独立危险因素。CAR处于第四四分位数的患者发生HT的风险显著高于处于第一四分位数的患者（比值比6.64，95%置信区间1.83至24.17，P = 0.004）。与CAR处于第一四分位数的患者相比，CAR处于第三四分位数的患者更易发生不良结局（比值比3.35，95%置信区间1.32至8.51，P = 0.01），CAR处于第四四分位数的患者也是如此（比值比7.33，95%置信区间2.62至20.50，<0.001）。
结论
缺血性卒中患者C反应蛋白与白蛋白的高比值与溶栓后HT风险增加及功能结局不良相关。
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