Demirel Mustafa E, Akunal Türel Canan
Emergency Medicine, Abant Izzet Baysal University Hospital, Bolu, TUR.
Neurology, Abant Izzet Baysal University Hospital, Bolu, TUR.
Cureus. 2023 Aug 10;15(8):e43258. doi: 10.7759/cureus.43258. eCollection 2023 Aug.
Background and objective Ischemic strokes account for the majority of all strokes. The severity of an acute ischemic stroke (AIS) can be estimated with the help of a number of different scoring systems. However, there is a need for bedside tests that will support the clinical diagnosis and thus help predict the severity of stroke. The research on the multi-inflammatory index (MII), which is calculated using hemogram parameters, has shown immense promise. In light of this, the aim of this study was to establish the association between MII and the severity of AIS. Methods The study included 452 ischemic stroke patients over the age of 18 years who presented to the hospital within 72 hours of the onset of symptoms. Demographic information such as patient age and gender, hemogram parameters, ratios, indices, hospitalization, and mortality status were all recorded. The demographic data, hemogram parameters, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and C-reactive protein (CRP)/lymphocyte ratio (CLR), and MII 1, 2, and 3 were compared between surviving and deceased patients. Results The MII-1, MII-2, and MII-3 index values were determined to be significantly low in the patients with Glasgow Coma Scale (GCS) scores of 13-15 compared to those with GCS scores ≤8, and in patients with National Institutes of Health Stroke Scale (NIHSS) score of 1-4 compared to those with scores of 5-14, 15-20, and ≥21. The NLR, CLR, PLR, MII-1, MII-2, and MII-3 index values were significantly higher in the non-survivors (PLR: p=0.004, all other values: p<0.001). The performances of multiple models developed for the mortality cut-off points were evaluated. Together with other factors, Model 1 included the MII-1, Model 2 the MII-2, and Model 3 the MII-3. Although there was no significant difference between the AUC values of the models, the highest sensitivity rate was reached with Model 2 (74.48%), and the highest specificity rate with Model 3 (90.62%). Conclusion Based on our findings, MII is a simple and practical biomarker that can be easily obtained from NLR, PLR, and CRP, and can help in the early detection of poor prognosis in AIS. NLR was found to be superior to PLR and CLR in distinguishing fatal AIS cases.
背景与目的 缺血性卒中占所有卒中的大多数。急性缺血性卒中（AIS）的严重程度可借助多种不同的评分系统进行评估。然而，需要床边检测来辅助临床诊断，从而有助于预测卒中的严重程度。对利用血常规参数计算得出的多炎症指数（MII）的研究已显示出巨大前景。有鉴于此，本研究的目的是确定MII与AIS严重程度之间的关联。方法 本研究纳入了452例18岁以上的缺血性卒中患者，这些患者在症状发作后72小时内入院。记录了患者年龄和性别等人口统计学信息、血常规参数、比率、指数、住院情况及死亡状态。比较了存活患者和死亡患者的人口统计学数据、血常规参数、中性粒细胞/淋巴细胞比率（NLR）、血小板/淋巴细胞比率（PLR）、C反应蛋白（CRP）/淋巴细胞比率（CLR）以及MII 1、2和3。结果 与格拉斯哥昏迷量表（GCS）评分≤8的患者相比，GCS评分13 - 15的患者的MII - 1、MII - 2和MII - 3指数值被确定为显著较低；与国立卫生研究院卒中量表（NIHSS）评分为5 - 14、15 - 20和≥21的患者相比，评分为1 - 4的患者的上述指数值也显著较低。非存活患者的NLR、CLR、PLR、MII - 1、MII - 2和MII - 3指数值显著更高（PLR：p = 0.004，所有其他值：p < 0.001）。评估了针对死亡临界点开发的多个模型的性能。模型1除其他因素外纳入了MII - 1，模型2纳入了MII - 2，模型3纳入了MII - 3。尽管各模型的曲线下面积（AUC）值之间无显著差异，但模型2达到了最高灵敏度率（74.48%），模型3达到了最高特异度率（90.62%）。结论 根据我们的研究结果，MII是一种简单实用的生物标志物，可轻松从NLR、PLR和CRP获得，有助于早期发现AIS预后不良情况。在区分致命性AIS病例方面，发现NLR优于PLR和CLR。
