Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases Suzhou Medical College of Soochow University Suzhou China.
Department of Epidemiology Tulane University School of Public Health and Tropical Medicine New Orleans LA.
J Am Heart Assoc. 2023 Jul 18;12(14):e030007. doi: 10.1161/JAHA.123.030007. Epub 2023 Jul 14.
Background We examined whether the relationship between baseline platelet count and clinical outcomes is modulated by HS-CRP (high-sensitivity C-reactive protein) in patients with ischemic stroke. Methods and Results A total of 3267 patients with ischemic stroke were included in the analysis. The primary outcome was a combination of death and major disability at 1 year after ischemic stroke. Secondary outcomes included major disability, death, vascular events, composite outcome of vascular events or death, and an ordered 7-level categorical score of the modified Rankin Scale at 1 year. Multivariate logistic regression and Cox proportional hazards regression models were used to assess the association between the baseline platelet count and clinical outcomes stratified by HS-CRP levels when appropriate. There was an interaction effect of platelet count and HS-CRP on the adverse clinical outcomes after ischemic stroke (all <0.05). The elevated platelet count was significantly associated with the primary outcome (odds ratio [OR], 3.14 [95% CI, 1.77-5.58]), major disability (OR, 2.07 [95% CI, 1.15-3.71]), death (hazard ratio [HR], 2.75 [95% CI, 1.31-5.79]), and composite outcome of vascular events or death (HR, 2.57 [95% CI, 1.38-4.87]) among patients with high HS-CRP levels (all <0.05). Conclusions The HS-CRP levels had a modifying effect on the association between platelet count and clinical outcomes in patients with ischemic stroke. Elevated platelet count was significantly associated with adverse clinical outcomes in patients with ischemic stroke with high HS-CRP levels, but not in those with low HS-CRP levels. These findings suggest that strategies for anti-inflammatory and antiplatelet therapy should be developed according to the results of both platelet and HS-CRP testing.
背景 我们研究了在缺血性脑卒中患者中，基线血小板计数与临床结局的关系是否受高敏 C 反应蛋白（hs-CRP）的调节。
方法和结果 共纳入 3267 例缺血性脑卒中患者进行分析。主要结局为缺血性脑卒中后 1 年时的死亡和主要残疾的联合结局。次要结局包括主要残疾、死亡、血管事件、血管事件或死亡的复合结局以及改良 Rankin 量表的 7 级有序分类评分在 1 年时的结果。当适当的时候，使用多变量逻辑回归和 Cox 比例风险回归模型评估基线血小板计数与 hs-CRP 水平分层后的临床结局之间的关联。血小板计数和 hs-CRP 对缺血性脑卒中后不良临床结局有交互作用（均<0.05）。血小板计数升高与主要结局（优势比[OR]，3.14[95%可信区间，1.77-5.58]）、主要残疾（OR，2.07[95%可信区间，1.15-3.71]）、死亡（HR，2.75[95%可信区间，1.31-5.79]）和血管事件或死亡的复合结局（HR，2.57[95%可信区间，1.38-4.87]）显著相关，这些结局在 hs-CRP 水平高的患者中（均<0.05）。
结论 hs-CRP 水平对血小板计数与缺血性脑卒中患者临床结局的关系有修饰作用。在 hs-CRP 水平高的缺血性脑卒中患者中，血小板计数升高与不良临床结局显著相关，但在 hs-CRP 水平低的患者中则无此相关性。这些发现表明，应根据血小板和 hs-CRP 检测的结果制定抗炎和抗血小板治疗策略。
