Cardiac parameters affect prognosis in patients with non-large atherosclerotic infarction

Ya-Ying Zeng,Li Wang,Wen-Jie Tang,Jin-Cai He,Wen-Bo Zhang,Bin-Bin Deng,Lin Cheng,Dan-Dan Geng

doi:10.1186/s10020-020-00260-5

Abstract

BackgroundAlthough large artery atherosclerosis (LAA) is the most common type of cerebral infarction, non-LAA is not uncommon. The purpose of this paper is to investigate the prognosis of patients with non-LAA and to establish a corresponding nomogram.Patients and methodsBetween June 2016 and June 2017, we had 1101 admissions for acute ischemic stroke (AIS). Of these, 848 were LAA and 253 were non-LAA. Patients were followed up every 3 months with a minimum of 1 year of follow-up. After excluding patients who were lost follow-up and patients who did not meet the inclusion criteria, a total of 152 non-LAA patients were included in this cohort study. After single-factor analysis and multifactor logistic regression analysis, the risk factors associated with prognosis were derived and different nomograms were developed based on these risk factors. After comparison, the best model is derived.ResultsLogistics regression found that the patient’s National Institutes of Health Stroke Scale (NIHSS) score, ejection fraction (EF), creatine kinase-MB (CK-MB), age, neutrophil-to-lymphocyte ratio (NLR), aspartate aminotransferase (AST), and serum albumin were independently related to the patient’s prognosis. We thus developed three models: model 1: single NIHSS score, AUC = 0.8534; model 2, NIHSS + cardiac parameters (CK-MB, EF), AUC = 0.9325; model 3, NIHSS + CK−MB + EF + age + AST + NLR + albumin, AUC = 0.9598. We compare the three models: model 1 vs model 2, z = − 2.85, p = 0.004; model 2 vs model 3, z = − 1.58, p = 0.122. Therefore, model 2 is considered to be the accurate and convenient model.ConclusionsPredicting the prognosis of patients with non-LAA is important, and our nomogram, built on the NIHSS and cardiac parameters, can predict the prognosis accurately and provide a powerful reference for clinical decision making.

Highlights

With the aging process, the incidence of cerebrovascular disease has been on the rise, and has become a major cause of death and disability, posing a serious threat to the life and health of the elderly (Feigin et al 2009; Thom 2006)
We consider the age of the patient (OR: 1.134, 95% CI: 0.963–1.336), National Institutes of Health Stroke Scale (NIHSS) (OR: 2.005, 95% CI: 1.242–3.234), neutrophil-to-lymphocyte ratio (NLR) (OR: 1.569, 95% CI: 0.925–2.663), albumin (OR: 0.554, 95% CI: 0.255–1.203), creatine kinase-MB (CK-MB) (OR: 1.126, 95% CI: 0.951–1.333), ejection fraction (EF) (OR: 0.696, 95% CI: 0.470–1.030), AST (OR: 0.858, 95% CI: 0.684–1.076), a total of 7 variables have independent effects on the prognosis of patients (P < 0.2) (Table 3)
Diabetes, NIHSS, and TG/high density lipoprotein (HDL) were included as risk factors for the prognosis of large artery atherosclerosis (LAA) patients

Summary

Introduction

The incidence of cerebrovascular disease has been on the rise, and has become a major cause of death and disability, posing a serious threat to the life and health of the elderly (Feigin et al 2009; Thom 2006). Stroke sources include large artery atherosclerosis (LAA), cardioembolism, Zeng et al Mol Med (2021) 27:2 small-artery occlusion, and other causes (Adams 1993; Arsava 2017). In acute ischemic stroke (AIS), the LAA type is the most common (Deng 2019). LAA type occupies the majority, non-LAA still has an important position in AIS, we should still pay attention to patients with non-LAA. Large artery atherosclerosis (LAA) is the most common type of cerebral infarction, non-LAA is not uncommon. The purpose of this paper is to investigate the prognosis of patients with non-LAA and to establish a corresponding nomogram

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Discussion

Conclusion