Shi Mengyao, Mao Xueyu, Wu Xuechun, Chu Min, Niu Huicong, Sun Lulu, Chang Xinyue, He Yu, Liu Yi, Guo Daoxia, Zhang Yonghong, Zhu Zhengbao, Zhao Jing
Department of Epidemiology, School of Public Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, MOE Key Laboratory of Geriatric Diseases and Immunology, Suzhou Medical College of Soochow University, Suzhou, People's Republic of China.
Department of neurology, Minhang Hospital, Fudan University, Shanghai, People's Republic of China.
Clin Epidemiol. 2024 Oct 9;16:707-716. doi: 10.2147/CLEP.S475408. eCollection 2024.
Prealbumin is a symbol of protein nutrition and is involved in anti-inflammatory and neuron regeneration, but its association with the prognosis of ischemic stroke remains unclear. We aimed to prospectively explore the associations between serum prealbumin levels and adverse clinical outcomes after ischemic stroke in a large-scale cohort study.
We measured serum prealbumin levels among 6609 ischemic stroke patients admitted at Minhang hospital. The primary outcome was composite of death and major disability (modified Rankin Scale [mRS] score ≥ 3) at 3 months after stroke onset, and secondary outcomes included death and the ordered 7-level categorical score of mRS.
During 3 months of follow-up, a total of 2118 patients developed the primary outcome. After multivariable adjustment, high prealbumin levels were associated with a decreased risk of primary outcome (odds ratio, 0.71; 95% CI, 0.59-0.85; < 0.0001) when 2 extreme quartiles were compared. Each unit increase of log-transformed prealbumin was associated with a 42% (95% CI, 28-53%) decreased risk of primary outcome. There was a better shift in the distribution of mRS score at 3 months with higher quartiles of serum prealbumin in ischemic stroke patients ( < 0.0001). Multivariable-adjusted spline regression model showed a linear relationship between prealbumin and the risk of primary outcome ( for linearity = 0.0036).
High serum prealbumin level was independently associated with decreased risks of adverse clinical outcomes among ischemic stroke patients. Our findings suggested that prealbumin may be a valuable prognostic biomarker and indicated the importance of keeping nourished in the daily life.
前白蛋白是蛋白质营养的一个指标，参与抗炎和神经元再生，但其与缺血性卒中预后的关系尚不清楚。我们旨在通过一项大规模队列研究，前瞻性地探讨血清前白蛋白水平与缺血性卒中后不良临床结局之间的关联。
我们测量了6609例在闵行医院住院的缺血性卒中患者的血清前白蛋白水平。主要结局是卒中发病后3个月时的死亡和严重残疾复合结局（改良Rankin量表[mRS]评分≥3），次要结局包括死亡和mRS的7级有序分类评分。
在3个月的随访期间，共有2118例患者出现主要结局。多变量调整后，当比较两个极端四分位数时，高前白蛋白水平与主要结局风险降低相关（比值比，0.71；95%可信区间，0.59 - 0.85；<0.0001）。对数转换后的前白蛋白每增加一个单位，主要结局风险降低42%（95%可信区间，28 - 53%）。缺血性卒中患者血清前白蛋白四分位数越高，3个月时mRS评分分布有更好的变化趋势（<0.0001）。多变量调整后的样条回归模型显示前白蛋白与主要结局风险之间存在线性关系（线性检验P = 0.0036）。
高血清前白蛋白水平与缺血性卒中患者不良临床结局风险降低独立相关。我们的研究结果表明前白蛋白可能是一种有价值的预后生物标志物，并提示了日常生活中保持营养的重要性。
