Research Article| Volume 29, ISSUE 4, 104653, April 2020

Clinical Utility of the Inflammatory Factors Combined With Lipid Markers in the Diagnostic and Prognostic Assessment of Ischemic Stroke: Based on Logistic Regression Models


      Background: In this study, we developed novel logistic regression models for the diagnostic and prognostic assessment of ischemic stroke. Methods: A total of 288 ischemic stroke patients and 300 controls admitted to The First Affiliated Hospital of Soochow University were included in the testing group. Two validation groups from The Affiliated Kunshan Hospital of Jiangsu University and The Second Affiliated Hospital of Soochow University were included to assess our novel assessment models. Results: Results from the testing group indicated that the diagnostic assessment model for ischemic stroke prediction was: Logit(P) = 437.116 − 87.329 (Hypertension) − 89.700 (Smoking history) − 87.427 (Family history of ischemic stroke) − .090 (high-density lipoprotein cholesterol [HDL-C]) − 1.984 (low-density lipoprotein cholesterol [LDL-C]) − 17.005 (Lp(a)) − 15.486 (Apo A/Apo B), and the final prognostic assessment model of ischemic stroke was: Logit(P) = 458.437−92.343 (Hypertension) − 89.763 (Smoking history) + .251 (NLR) − .088 (HDL-C) − 1.994 (LDL-C) − 2.883 (hs-CRP) − .058 (IL-6) − 6.356 (TNF-α) − 16.485 (Lp(a)) − 17.658 (Apo A/Apo B). In the validation groups, our novel diagnostic assessment model showed good identification (with 87.5% sensitivity and 84.2% specificity in The Affiliated Kunshan Hospital of Jiangsu University, with 85.5% sensitivity and 89.0% specificity in The Second Affiliated Hospital of Soochow University). Moreover, our novel prognostic assessment model has a high value in identifying poor prognosis patients in the validation groups from The Affiliated Kunshan Hospital of Jiangsu University (χ2 = 8.461, P = .004), and The Second Affiliated Hospital of Soochow University (χ2 = 7.844, P = .005). Conclusions: The diagnostic and prognostic assessment models we have established are of great value in the diagnosis and prognostic evaluation of ischemic stroke.

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        • Zhu M.
        • Li N.
        • Luo P.
        • et al.
        Peripheral blood leukocyte expression of lncRNA MIAT and its diagnostic and prognostic value in ischemic stroke.
        J Stroke Cerebrovasc Dis. 2018; 27: 326-337
        • Bei Y.
        • Shi C.
        • Zhang Z.
        • et al.
        Advance for cardiovascular health in China.
        J Cardiovasc Transl Res. 2019; 12: 165-170
        • Wang W.
        • Jiang B.
        • Sun H.
        • et al.
        Prevalence, incidence, and mortality of stroke in China: results from a nationwide population-based survey of 480,687 adults.
        Circulation. 2017; 135: 759-771
        • Mozaffarian D.
        • Benjamin E.J.
        • Go A.S.
        • et al.
        Heart disease and stroke statistics-2016 update: a report from the American Heart Association.
        Circulation. 2016; 133: e38-360
        • Kim A.S.
        • Cahill E.
        • Cheng N.T.
        Global stroke belt: geographic variation in stroke burden worldwide.
        Stroke. 2015; 46: 3564-3570
        • Zhou X.
        • Chen J.
        • Zhang Q.
        • et al.
        Prognostic value of plasma soluble corin in patients with acute myocardial infarction.
        J Am Coll Cardiol. 2016; 67: 2008-2014
        • Wardlaw J.M.
        • Murray V.
        • Berge E.
        • et al.
        Recombinant tissue plasminogen activator for acute ischaemic stroke: an updated systematic review and meta-analysis.
        Lancet. 2012; 379: 2364-2372
        • Rangaraju S.
        • Jovin T.G.
        • Frankel M.
        • et al.
        Neurologic examination at 24 to 48 hours predicts functional outcomes in basilar artery occlusion stroke.
        Stroke. 2016; 47: 2534-2540
        • Goebel M.
        • Vaida F.
        • Kahn C.
        • et al.
        A novel algorithm for improving the diagnostic accuracy of prehospital ST-elevation myocardial infarction.
        Prehosp Disaster Med. 2019; 11: 1-8
        • Altaf A.
        • Shah H.
        • Salahuddin M.
        Gender based differences in clinical and angiographic characteristics and outcomes of Acute Coronary Syndrome (ACS) in Asian population.
        Pak J Med Sci. 2019; 35: 1349-1354
        • Gragnano F.
        • Spedicato V.
        • Frigoli E.
        • et al.
        ECG analysis in patients with acute coronary syndrome undergoing invasive management: rationale and design of the electrocardiography sub-study of the MATRIX trial.
        J Electrocardiol. 2019; 57: 44-54
        • Srilatha K.
        • Bobby Z.
        • Subrahmanyam D.K.
        • et al.
        Insulin resistance and elevated C-reactive protein among first-degree relatives of ischemic stroke patients.
        Diabetes Metab Syndr. 2017; 11: S873-S878
        • Sandu R.E.
        • Dumbrava D.
        • Surugiu R.
        • et al.
        Cellular and molecular mechanisms underlying non-pharmaceutical ischemic stroke therapy in aged subjects.
        Int J Mol Sci. 2017; 19: E99
        • Salisbury D.
        • Bronas U.
        Inflammation and immune system contribution to the etiology of atherosclerosis: mechanisms and methods of assessment.
        Nurs Res. 2014; 63: 375-385
        • Jiang Y.
        • Liu X.
        • Du Y.
        • et al.
        rs1234313 and rs45454293 are risk factors of cerebral arterial thrombosis, large artery atherosclerosis, and carotid plaque in the Han Chinese population: a case-control study.
        BMC Neurol. 2019; 19: 31
        • Marchione P.
        • Vento C.
        • Morreale M.
        • et al.
        Atorvastatin treatment and carotid plaque morphology in first-ever atherosclerotic transient ischemic attack/stroke: a case-control study.
        J Stroke Cerebrovasc Dis. 2015; 24: 138-143
        • Li Z.
        • Bai Y.
        • Li W.
        • et al.
        Carotid vulnerable plaques are associated with circulating leukocytes in acute ischemic stroke patients: an clinical study based on contrast-enhanced ultrasound.
        Sci Rep. 2018; 8: 8849
        • Zhao S.
        • Tian Y.
        • Yan H.
        • et al.
        Association between low-density lipoprotein cholesterol (LDL-C) level and unfavorable outcomes in participants of ischemic stroke without diabetes: a multi-center retrospective Study.
        Med Sci Monit. 2019; 25: 5934-5941
        • Zeng N.
        • Wang A.
        • Xu T.
        • et al.
        Co-effect of serum galectin-3 and high-density lipoprotein cholesterol on the prognosis of acute ischemic stroke.
        J Stroke Cerebrovasc Dis. 2019; 28: 1879-1885
        • Zhang Z.
        • Chen W.
        • Wang Y.
        • et al.
        Antioxidant and anti-inflammatory effects of DHK-medicated serum on high glucose-induced injury in endothelial cells.
        Mol Med Rep. 2017; 16: 7745-7751
        • Zhang J.
        • Yuan L.
        • Zhang X.
        • et al.
        Altered long non-coding RNA transcriptomic profiles in brain microvascular endothelium after cerebral ischemia.
        Exp Neurol. 2016; 277: 162-170
        • Zhang X.
        • Tang X.
        • Liu K.
        • et al.
        Long noncoding RNA malat1 regulates cerebrovascular pathologies in ischemic stroke.
        J Neurosci. 2017; 37: 1797-1806
        • Ng S.Y.
        • Lin L.
        • Soh B.S.
        • et al.
        Long noncoding RNAs in development and disease of the central nervous system.
        Trends Genet. 2013; 29: 461-468
        • Congrains A.
        • Kamide K.
        • Katsuya T.
        • et al.
        CVD-associated non-coding RNA, ANRIL, modulates expression of atherogenic pathways in VSMC.
        Biochem Biophys Res Commun. 2012; 419: 612-616
        • Pierini A.
        • Gori E.
        • Lippi I.
        • et al.
        Neutrophil-to-lymphocyte ratio, nucleated red blood cells and erythrocyte abnormalities in canine systemic inflammatory response syndrome.
        Res Vet Sci. 2019; 126: 150-154
        • Kablak-Ziembicka A.
        • Przewlocki T.
        • Sokołowski A.
        • et al.
        Carotid intima-media thickness, hs-CRP and TNF-α are independently associated with cardiovascular event risk in patients with atherosclerotic occlusive disease.
        Atherosclerosis. 2011; 214: 185-190
        • Chen M.
        • Yang Y.
        A meta-analysis on associations of IL-6 and IL-10 polymorphisms with susceptibility to ischemic stroke.
        J Neuroimmunol. 2019; 335577004
        • Lappegård J.
        • Ellingsen T.S.
        • Hindberg K.
        • et al.
        Impact of chronic inflammation, assessed by hs-CRP, on the association between red cell distribution width and arterial cardiovascular disease: the Tromsø study.
        TH Open. 2018; 2: e182-e189
        • Albers J.J.
        • Slee A.
        • O'Brien K.D.
        • et al.
        Relationship of apolipoproteins A-1 and B, and lipoprotein(a) to cardiovascular outcomes: the AIM-HIGH trial (Atherothrombosis Intervention in Metabolic Syndrome with Low HDL/High Triglyceride and Impact on Global Health Outcomes).
        J Am Coll Cardiol. 2013; 62: 1575-1579
        • Bodde M.C.
        • Hermans M.P.J.
        • Jukema J.W.
        • et al.
        Apolipoproteins A1, B, and apoB/apoA1 ratio are associated with first ST-segment elevation myocardial infarction but not with recurrent events during long-term follow-up.
        Clin Res Cardiol. 2019; 108: 520-538