He Qian, Wang Miaoran, Zhu Haoyue, Xiao Ying, Wen Rui, Liu Xiaoqing, Shi Yangdi, Zhang Linzhi, Wang Yu, Xu Bing
Shenyang Tenth People's Hospital (Shenyang Chest Hospital), Shenyang, China.
Qionglai Traditional Chinese Medicine Hospital, Chengdu, China.
Front Aging Neurosci. 2024 Aug 30;16:1450863. doi: 10.3389/fnagi.2024.1450863. eCollection 2024.
We aimed to use lactate dehydrogenase (LDH) as a marker of inflammation burden and quantify post-stroke inflammation's direct and indirect effect on functional disability.
We analyzed 5,129 patients with acute ischemic stroke (AIS) admitted to Shenyang First People's Hospital. Stroke recurrence and functional outcome measured by the modified Rankin Scale (mRS) were assessed at 90 days. Functional disability was defined as mRS score > 2. Receiver operating characteristic curve and restricted cubic spline (RCS) analysis were conducted to illustrate the associations between LDH levels and 90-day functional outcomes in patients with AIS. Mediation analyses were performed to examine the potential causal chain in which stroke recurrence may mediate the relationship between LDH and functional outcome. Positive correlation between LDH and hs-CRP was found and mediation effects of stroke recurrence in the association between LDH or hs-CRP and functional disability were both less than 20%. Sensitivity analyses in different subgroups showed comparable results.
Among 5,129 included AIS patients, the median (IQR) level of LDH was 186 (161-204.4) U/L. Functional disability was seen in 1200 (23.4%) patients and recurrence was observed in 371(7.2%) patients at 90-day follow-up. Each standard deviation increase in the concentration of LDH was linked to an increased risk of functional disability (adjusted odds ratio[aOR], 1.07; 95%CI,1.04-1.09) and stroke recurrence (aOR,1.02; 95%CI, 1.01-1.04) within 90 days. The highest quartile of LDH (>204.2 U/L) had an elevated risk of suffering functional disability (aOR, 1.21; 95%CI, 1.00-1.47) and recurrence (aOR, 1.21; 95%CI,1.00-1.47) compared with the lowest quartile of LDH (<161 U/L). Stroke recurrence during follow-up explained 12.90% (95%CI, 6.22-21.16%) of the relationship between LDH and functional disability. Positive correlation between LDH and hs-CRP was found and mediation effects of recurrence in the association between LDH or hs-CRP and functional disability were both less than 20%. Sensitivity analyses in different subgroups showed comparable results.
The relationship between LDH and functional disability at 90 days among AIS patients is partially mediated by stroke recurrence, accounting for less than 20%. LDH deserves equal attention as hs-CRP in predicting recurrence and functional outcome. In addition to traditional secondary prevention measures, innovative anti-inflammatory strategies warrant further investigation.
我们旨在将乳酸脱氢酶（LDH）用作炎症负担的标志物，并量化中风后炎症对功能残疾的直接和间接影响。
我们分析了5129例入住沈阳市第一人民医院的急性缺血性中风（AIS）患者。在90天时评估中风复发情况以及采用改良Rankin量表（mRS）测量的功能结局。功能残疾定义为mRS评分>2。进行受试者工作特征曲线和受限立方样条（RCS）分析，以阐明AIS患者LDH水平与90天功能结局之间的关联。进行中介分析以检验潜在的因果链，即中风复发可能介导LDH与功能结局之间的关系。发现LDH与hs-CRP呈正相关，且中风复发在LDH或hs-CRP与功能残疾之间关联中的中介作用均小于20%。不同亚组的敏感性分析显示了可比的结果。
在纳入的5129例AIS患者中，LDH的中位数（IQR）水平为186（161 - 204.4）U/L。在90天随访时，1200例（23.4%）患者出现功能残疾，371例（7.2%）患者出现复发。LDH浓度每增加一个标准差，与90天内功能残疾风险增加（调整优势比[aOR]，1.07；95%CI，1.04 - 1.09）以及中风复发风险增加（aOR，1.02；95%CI，1.01 - 1.04）相关。与LDH最低四分位数（<161 U/L）相比，LDH最高四分位数（>204.2 U/L）出现功能残疾（aOR，1.21；95%CI，1.00 - 1.47）和复发（aOR，1.21；95%CI，1.00 - 1.47）的风险升高。随访期间中风复发解释了LDH与功能残疾之间关系的12.90%（95%CI，6.22 - 21.16%）。发现LDH与hs-CRP呈正相关，且复发在LDH或hs-CRP与功能残疾之间关联中的中介作用均小于20%。不同亚组的敏感性分析显示了可比的结果。
AIS患者90天时LDH与功能残疾之间的关系部分由中风复发介导，占比小于20%。在预测复发和功能结局方面，LDH应与hs-CRP受到同等关注。除了传统的二级预防措施外，创新的抗炎策略值得进一步研究。
