Lin Chenhui, Zhang Heyu, Xiao Fangyi, Tu Yujie, Lin Yaoyao, Zhan Luqian, Lin Yisi, Li Yanwei, Xie Chenglong, Chen Yanyan
Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China.
Department of Cardiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China.
J Inflamm Res. 2025 Mar 18;18:4019-4035. doi: 10.2147/JIR.S505038. eCollection 2025.
Delirium is an acute fluctuating impairment of attention and awareness, common in acute ischemic stroke (AIS). This study aimed to evaluate the prognostic significance of delirium for neurological function at 3 months post-stroke, and develop a predictive model integrating delirium and biomarkers to enhance prognostic accuracy.
We conducted a prospective cohort study of patients admitted to the stroke unit (n=722). All patients were screened for daily delirium during clinical care. Plasma biomarkers were measured within 24 hours after admission. The main outcomes were evaluated with the 3-months modified Rankin Scale (mRS).
Delirium developed in 10.2% of patients during the acute phase of stroke. Patients with post-stroke delirium (PSD) was significantly older (median age 74 vs 68 years, <0.001), more likely to have pre-stroke cognitive impairment (14.9% vs 4.8%, =0.001), a higher prevalence of cardiovascular history (35.1% vs 16.2%, <0.001). PSD was also associated with higher scores of NIHSS (14.3 vs 9.1, <0.001) and greater scores of mRS (3.0 vs 1.5, <0.001) at admission. PSD patients showed worse outcomes, with elevated NIHSS and mRS scores at discharge and 3-month follow-up, as well as higher mortality rates (5.4% vs 1.4%, =0.025). Biomarker analysis revealed increased plasma levels of inflammatory (white blood cells, neutrophils, C-reactive protein) and coagulation biomarkers (fibrinogen, D-dimer) in PSD patients, particularly those with poorer outcomes (<0.01). Our model, which incorporated delirium and biomarkers of inflammation and coagulation dysfunction, demonstrated strong predictive accuracy for adverse outcomes at 3 months with an AUC of 0.779 (95% CI=0.736-0.822), with clinical utility confirmed by decision curve analysis.
PSD is a strong independent predictor of poor 3-month outcomes in AIS, including higher mortality and disability. Our findings highlight the critical role of inflammation and coagulation dysfunction in the pathogenesis of PSD. Furthermore, we present the clinical utility of a predictive model integrating delirium and relevant biomarkers to assess the risk of adverse outcomes at 3 months, suggesting potential targets for intervention.
谵妄是一种急性波动性注意力和意识障碍，在急性缺血性卒中（AIS）中很常见。本研究旨在评估谵妄对卒中后3个月神经功能的预后意义，并建立一个整合谵妄和生物标志物的预测模型，以提高预后准确性。
我们对入住卒中单元的患者（n = 722）进行了一项前瞻性队列研究。在临床护理期间对所有患者进行每日谵妄筛查。入院后24小时内检测血浆生物标志物。主要结局采用3个月改良Rankin量表（mRS）进行评估。
10.2%的患者在卒中急性期发生谵妄。卒中后谵妄（PSD）患者年龄显著更大（中位年龄74岁对68岁，<0.001），更可能有卒中前认知障碍（14.9%对4.8%，=0.001），心血管病史患病率更高（35.1%对16.2%，<0.001）。PSD还与入院时较高的美国国立卫生研究院卒中量表（NIHSS）评分（14.3对9.1，<0.001）和较高的mRS评分（3.0对1.5，<0.001）相关。PSD患者结局更差，出院时和3个月随访时NIHSS和mRS评分升高，死亡率也更高（5.4%对1.4%，=0.025）。生物标志物分析显示，PSD患者血浆中炎症生物标志物（白细胞、中性粒细胞、C反应蛋白）和凝血生物标志物（纤维蛋白原、D-二聚体）水平升高，尤其是结局较差的患者（<0.01）。我们的模型纳入了谵妄以及炎症和凝血功能障碍的生物标志物，对3个月时的不良结局显示出很强的预测准确性，曲线下面积（AUC）为0.779（95%可信区间=0.736 - 0.822），决策曲线分析证实了其临床实用性。
PSD是AIS患者3个月不良结局的强有力独立预测因素，包括更高的死亡率和残疾率。我们的研究结果突出了炎症和凝血功能障碍在PSD发病机制中的关键作用。此外，我们展示了一个整合谵妄和相关生物标志物的预测模型在评估3个月不良结局风险方面的临床实用性，提示了潜在的干预靶点。
