The joint effects of inflammation and renal function status on in-hospital outcomes in patients with acute ischemic stroke treated with intravenous thrombolysis
Abstract Objective We aimed to determine the predictive value of renal function status [estimating glomerular filtration rate (eGFR)] in conjunction with inflammatory biomarkers [white blood cell(WBC) and C-reactive protein (CRP)] for in-hospital outcomes in acute ischemic stroke (AIS) patients trea...
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2024-12-01
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| Online Access: | https://doi.org/10.1186/s12883-024-04002-6 |
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| author | Zhichao Huang Xiaoyue Zhu Xiuman Xu Yi Wang Yafang Zhu Dongqin Chen Yongjun Cao Xia Zhang |
| author_facet | Zhichao Huang Xiaoyue Zhu Xiuman Xu Yi Wang Yafang Zhu Dongqin Chen Yongjun Cao Xia Zhang |
| author_sort | Zhichao Huang |
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| description | Abstract Objective We aimed to determine the predictive value of renal function status [estimating glomerular filtration rate (eGFR)] in conjunction with inflammatory biomarkers [white blood cell(WBC) and C-reactive protein (CRP)] for in-hospital outcomes in acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT). Methods We retrospectively screened a total of 409 AIS patients treated with IVT. The study participants were classified into two groups according to post-stroke pneumonia or functional outcome. They were divided into four groups according to the cut-offs of inflammatory biomarkers and eGFR by receiver operating characteristics(ROC) curves for two outcomes of post-stroke pneumonia and functional status: WBC↓/eGFR↑, WBC↓/eGFR↓, WBC↑/eGFR↑, and WBC↑/eGFR↓for post-stroke pneumonia; and CRP↓/eGFR↑, CRP↓/eGFR↓, CRP↑/eGFR↑, and CRP↑/eGFR↓for functional outcome. Logistic regression models were used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) of post-stroke pneumonia or at-discharge functional outcome, using the WBC↓/eGFR↑group or CRP↓/eGFR↑group as the reference. The Net Reclassification Index (NRI) and the Integrated Discrimination Improvement (IDI) were calculated to analyze the combined predictive value. Results Compared with patients in WBC↓/eGFR↑group, those in WBC↑/eGFR↑group had increased risk of post-stroke pneumonia (OR 5.15, 95% CI 1.67–15.87) and poor functional outcome (OR 5.95, 95% CI 2.25–15.74). Furthermore, patients in WBC↑/ eGFR↓group had the highest risk of clinical outcomes (all P value for trend < 0.001), the multivariable-adjusted ORs (95% CIs) were 7.04 (2.42–20.46) for post-stroke pneumonia and 8.64 (3.30–22.65) for poor functional outcome. The addition of WBC and eGFR to the basic model significantly improved risk prediction for post-stroke pneumonia (category-free NRI 69.0%, 95% CI 47.3%–90.7%; IDI 5.4%, 95% CI 2.6%–8.3%) and functional outcome (category-free NRI 59.4%, 95% CI 39.2%–79.9%; IDI 5.3%, 95% CI 2.9%–7.8%). Similarly, when we added CRP and eGFR to the basic model with conventional risk factors, the risk discrimination and prediction for post-stroke pneumonia and functional outcome was also significantly improved. Conclusion Combining renal function status and inflammatory biomarkers within 4.5 h after onset could better predict in-hospital outcomes of AIS patients with IVT. |
| format | Article |
| id | doaj-art-5b4480fd48114dfea0a2a36fbc70031a |
| institution | Kabale University |
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| language | English |
| publishDate | 2024-12-01 |
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| spelling | doaj-art-5b4480fd48114dfea0a2a36fbc70031a2025-01-05T12:34:11ZengBMCBMC Neurology1471-23772024-12-0124111010.1186/s12883-024-04002-6The joint effects of inflammation and renal function status on in-hospital outcomes in patients with acute ischemic stroke treated with intravenous thrombolysisZhichao Huang0Xiaoyue Zhu1Xiuman XuYi Wang2Yafang Zhu3Dongqin Chen4Yongjun Cao5Xia Zhang6Department of Neurology and Clinical Research Center of Neurological Disease, the Second Affiliated Hospital of Soochow UniversityDepartment of Clinical Nutrition, Suzhou Municipal HospitalDepartment of Neurology and Clinical Research Center of Neurological Disease, the Second Affiliated Hospital of Soochow UniversityDepartment of Neurology and Clinical Research Center of Neurological Disease, the Second Affiliated Hospital of Soochow UniversityDepartment of Neurology and Clinical Research Center of Neurological Disease, the Second Affiliated Hospital of Soochow UniversityDepartment of Neurology and Clinical Research Center of Neurological Disease, the Second Affiliated Hospital of Soochow UniversityDepartment of Neurology and Clinical Research Center of Neurological Disease, the Second Affiliated Hospital of Soochow UniversityAbstract Objective We aimed to determine the predictive value of renal function status [estimating glomerular filtration rate (eGFR)] in conjunction with inflammatory biomarkers [white blood cell(WBC) and C-reactive protein (CRP)] for in-hospital outcomes in acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT). Methods We retrospectively screened a total of 409 AIS patients treated with IVT. The study participants were classified into two groups according to post-stroke pneumonia or functional outcome. They were divided into four groups according to the cut-offs of inflammatory biomarkers and eGFR by receiver operating characteristics(ROC) curves for two outcomes of post-stroke pneumonia and functional status: WBC↓/eGFR↑, WBC↓/eGFR↓, WBC↑/eGFR↑, and WBC↑/eGFR↓for post-stroke pneumonia; and CRP↓/eGFR↑, CRP↓/eGFR↓, CRP↑/eGFR↑, and CRP↑/eGFR↓for functional outcome. Logistic regression models were used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) of post-stroke pneumonia or at-discharge functional outcome, using the WBC↓/eGFR↑group or CRP↓/eGFR↑group as the reference. The Net Reclassification Index (NRI) and the Integrated Discrimination Improvement (IDI) were calculated to analyze the combined predictive value. Results Compared with patients in WBC↓/eGFR↑group, those in WBC↑/eGFR↑group had increased risk of post-stroke pneumonia (OR 5.15, 95% CI 1.67–15.87) and poor functional outcome (OR 5.95, 95% CI 2.25–15.74). Furthermore, patients in WBC↑/ eGFR↓group had the highest risk of clinical outcomes (all P value for trend < 0.001), the multivariable-adjusted ORs (95% CIs) were 7.04 (2.42–20.46) for post-stroke pneumonia and 8.64 (3.30–22.65) for poor functional outcome. The addition of WBC and eGFR to the basic model significantly improved risk prediction for post-stroke pneumonia (category-free NRI 69.0%, 95% CI 47.3%–90.7%; IDI 5.4%, 95% CI 2.6%–8.3%) and functional outcome (category-free NRI 59.4%, 95% CI 39.2%–79.9%; IDI 5.3%, 95% CI 2.9%–7.8%). Similarly, when we added CRP and eGFR to the basic model with conventional risk factors, the risk discrimination and prediction for post-stroke pneumonia and functional outcome was also significantly improved. Conclusion Combining renal function status and inflammatory biomarkers within 4.5 h after onset could better predict in-hospital outcomes of AIS patients with IVT.https://doi.org/10.1186/s12883-024-04002-6Acute ischemic strokeEstimating glomerular filtration rateWhite blood cellC-reactive proteinIntravenous thrombolysisPrognosis |
| spellingShingle | Zhichao Huang Xiaoyue Zhu Xiuman Xu Yi Wang Yafang Zhu Dongqin Chen Yongjun Cao Xia Zhang The joint effects of inflammation and renal function status on in-hospital outcomes in patients with acute ischemic stroke treated with intravenous thrombolysis BMC Neurology Acute ischemic stroke Estimating glomerular filtration rate White blood cell C-reactive protein Intravenous thrombolysis Prognosis |
| title | The joint effects of inflammation and renal function status on in-hospital outcomes in patients with acute ischemic stroke treated with intravenous thrombolysis |
| title_full | The joint effects of inflammation and renal function status on in-hospital outcomes in patients with acute ischemic stroke treated with intravenous thrombolysis |
| title_fullStr | The joint effects of inflammation and renal function status on in-hospital outcomes in patients with acute ischemic stroke treated with intravenous thrombolysis |
| title_full_unstemmed | The joint effects of inflammation and renal function status on in-hospital outcomes in patients with acute ischemic stroke treated with intravenous thrombolysis |
| title_short | The joint effects of inflammation and renal function status on in-hospital outcomes in patients with acute ischemic stroke treated with intravenous thrombolysis |
| title_sort | joint effects of inflammation and renal function status on in hospital outcomes in patients with acute ischemic stroke treated with intravenous thrombolysis |
| topic | Acute ischemic stroke Estimating glomerular filtration rate White blood cell C-reactive protein Intravenous thrombolysis Prognosis |
| url | https://doi.org/10.1186/s12883-024-04002-6 |
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