Vishal Mehta, Akhya Sharma, Divya Jyoti, Rathod Prabhakar, Ritesh Kumar, Rishi T Guria, Chandra B Sharma
{"title":"纤维蛋白原作为急性缺血性卒中早期神经退化的预测因子——来自印度人群的证据。","authors":"Vishal Mehta, Akhya Sharma, Divya Jyoti, Rathod Prabhakar, Ritesh Kumar, Rishi T Guria, Chandra B Sharma","doi":"10.1177/11795735231156349","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Early neurological deterioration (END) is a common occurrence in ischemic stroke and contributes significantly to poor outcomes. Although multiple factors that predict END have already been identified, the role of fibrinogen - a key component of the coagulation pathway, is controversial.</p><p><strong>Objective: </strong>To assess the role of fibrinogen in predicting END and poor hospital outcome in patients with acute ischemic stroke.</p><p><strong>Design: </strong>Single-centre prospective observational study.</p><p><strong>Methods: </strong>141 patients with acute ischemic stroke were analyzed in this prospective observational study from a single tertiary-care hospital in East India. END was defined as a worsening of ≥2 points on the National Institutes of Health Stroke Scale (NIHSS) within 7 days of admission. A score of 3-5 on the Modified Rankin Scale (mRS), a stroke recurrence event or death during hospital stay was considered poor hospital outcome. We performed univariate analysis using age, sex, body-mass index (BMI), hypertension, diabetes, NIHSS scores, stroke etiology, blood glucose and lipid parameters and plasma fibrinogen to develop a logistic regression model to establish the independent predictors of END and poor outcome.</p><p><strong>Results: </strong>Age (Odds Ratio (OR) 1.034 [95% CI 1.001-1.069], <i>P</i> = .046), NIHSS score at admission (OR 1.152 [95% CI 1.070-1.240], <i>P</i> < .001) and fibrinogen (OR 1.011 [95%CI 1.006-1.015], <i>P</i> < .001) were independent predictors of END in patients with acute ischemic stroke. Factors independently associated with poor outcome were NIHSS score at admission (OR 1.257 [95% CI 1.150-1.357], <i>P</i> < .001), fasting plasma glucose (OR 1.007 [95% CI 1.001-1.013], <i>P</i> = .020), and fibrinogen [OR 1.004 [95% CI 1.000-1.007], <i>P</i> = .038).</p><p><strong>Conclusion: </strong>The significant role of fibrinogen in determining neurological worsening and subsequent poor outcomes in patients with acute ischemic stroke may help in early prognostication and guided therapeutic interventions.</p>","PeriodicalId":15218,"journal":{"name":"Journal of Central Nervous System Disease","volume":null,"pages":null},"PeriodicalIF":2.6000,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a4/02/10.1177_11795735231156349.PMC9909079.pdf","citationCount":"0","resultStr":"{\"title\":\"Fibrinogen as a Predictor of Early Neurological Deterioration in Acute Ischemic Stroke - Evidence From the Indian Population.\",\"authors\":\"Vishal Mehta, Akhya Sharma, Divya Jyoti, Rathod Prabhakar, Ritesh Kumar, Rishi T Guria, Chandra B Sharma\",\"doi\":\"10.1177/11795735231156349\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Early neurological deterioration (END) is a common occurrence in ischemic stroke and contributes significantly to poor outcomes. Although multiple factors that predict END have already been identified, the role of fibrinogen - a key component of the coagulation pathway, is controversial.</p><p><strong>Objective: </strong>To assess the role of fibrinogen in predicting END and poor hospital outcome in patients with acute ischemic stroke.</p><p><strong>Design: </strong>Single-centre prospective observational study.</p><p><strong>Methods: </strong>141 patients with acute ischemic stroke were analyzed in this prospective observational study from a single tertiary-care hospital in East India. END was defined as a worsening of ≥2 points on the National Institutes of Health Stroke Scale (NIHSS) within 7 days of admission. A score of 3-5 on the Modified Rankin Scale (mRS), a stroke recurrence event or death during hospital stay was considered poor hospital outcome. We performed univariate analysis using age, sex, body-mass index (BMI), hypertension, diabetes, NIHSS scores, stroke etiology, blood glucose and lipid parameters and plasma fibrinogen to develop a logistic regression model to establish the independent predictors of END and poor outcome.</p><p><strong>Results: </strong>Age (Odds Ratio (OR) 1.034 [95% CI 1.001-1.069], <i>P</i> = .046), NIHSS score at admission (OR 1.152 [95% CI 1.070-1.240], <i>P</i> < .001) and fibrinogen (OR 1.011 [95%CI 1.006-1.015], <i>P</i> < .001) were independent predictors of END in patients with acute ischemic stroke. Factors independently associated with poor outcome were NIHSS score at admission (OR 1.257 [95% CI 1.150-1.357], <i>P</i> < .001), fasting plasma glucose (OR 1.007 [95% CI 1.001-1.013], <i>P</i> = .020), and fibrinogen [OR 1.004 [95% CI 1.000-1.007], <i>P</i> = .038).</p><p><strong>Conclusion: </strong>The significant role of fibrinogen in determining neurological worsening and subsequent poor outcomes in patients with acute ischemic stroke may help in early prognostication and guided therapeutic interventions.</p>\",\"PeriodicalId\":15218,\"journal\":{\"name\":\"Journal of Central Nervous System Disease\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2023-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a4/02/10.1177_11795735231156349.PMC9909079.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Central Nervous System Disease\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1177/11795735231156349\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Central Nervous System Disease","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/11795735231156349","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景:早期神经功能恶化(END)在缺血性脑卒中中很常见，是导致预后不良的重要因素。虽然预测END的多种因素已经被确定，但纤维蛋白原(凝血途径的关键成分)的作用仍存在争议。目的:探讨纤维蛋白原在预测急性缺血性脑卒中患者预后及预后不良中的作用。设计:单中心前瞻性观察研究。方法:在这项前瞻性观察研究中，对东印度一家三级医院的141例急性缺血性卒中患者进行了分析。END定义为入院后7天内美国国立卫生研究院卒中量表(NIHSS)恶化≥2分。在改良兰金量表(mRS)得分为3-5分时，住院期间中风复发或死亡被认为是不良的医院预后。我们使用年龄、性别、身体质量指数(BMI)、高血压、糖尿病、NIHSS评分、卒中病因、血糖和血脂参数以及血浆纤维蛋白原进行单变量分析，建立logistic回归模型，建立END和不良预后的独立预测因子。结果:年龄(比值比(OR) 1.034 [95%CI 1.001-1.069]， P = 0.046)、入院时NIHSS评分(OR 1.152 [95%CI 1.070-1.240]， P < 0.001)和纤维蛋白原(OR 1.011 [95%CI 1.006-1.015]， P < 0.001)是急性缺血性卒中患者END的独立预测因素。与预后不良独立相关的因素是入院时NIHSS评分(OR 1.257 [95% CI 1.150-1.357]， P < .001)、空腹血糖(OR 1.007 [95% CI 1.001-1.013]， P = .020)和纤维蛋白原[OR 1.004 [95% CI 1.000-1.007]， P = .038)。结论:纤维蛋白原在判断急性缺血性脑卒中患者神经系统恶化及其预后不良中的重要作用可能有助于早期预后和指导治疗干预。
Fibrinogen as a Predictor of Early Neurological Deterioration in Acute Ischemic Stroke - Evidence From the Indian Population.
Background: Early neurological deterioration (END) is a common occurrence in ischemic stroke and contributes significantly to poor outcomes. Although multiple factors that predict END have already been identified, the role of fibrinogen - a key component of the coagulation pathway, is controversial.
Objective: To assess the role of fibrinogen in predicting END and poor hospital outcome in patients with acute ischemic stroke.
Methods: 141 patients with acute ischemic stroke were analyzed in this prospective observational study from a single tertiary-care hospital in East India. END was defined as a worsening of ≥2 points on the National Institutes of Health Stroke Scale (NIHSS) within 7 days of admission. A score of 3-5 on the Modified Rankin Scale (mRS), a stroke recurrence event or death during hospital stay was considered poor hospital outcome. We performed univariate analysis using age, sex, body-mass index (BMI), hypertension, diabetes, NIHSS scores, stroke etiology, blood glucose and lipid parameters and plasma fibrinogen to develop a logistic regression model to establish the independent predictors of END and poor outcome.
Results: Age (Odds Ratio (OR) 1.034 [95% CI 1.001-1.069], P = .046), NIHSS score at admission (OR 1.152 [95% CI 1.070-1.240], P < .001) and fibrinogen (OR 1.011 [95%CI 1.006-1.015], P < .001) were independent predictors of END in patients with acute ischemic stroke. Factors independently associated with poor outcome were NIHSS score at admission (OR 1.257 [95% CI 1.150-1.357], P < .001), fasting plasma glucose (OR 1.007 [95% CI 1.001-1.013], P = .020), and fibrinogen [OR 1.004 [95% CI 1.000-1.007], P = .038).
Conclusion: The significant role of fibrinogen in determining neurological worsening and subsequent poor outcomes in patients with acute ischemic stroke may help in early prognostication and guided therapeutic interventions.
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