Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases

Journal：Internal and Emergency Medicine

Publication type: Original Contributions

IF(IF): 5.472

PMID: 35986833 Link To Pubmed Full text Download

Stroke is a leading cause of death and disability worldwide, especially in mid- and low-income countries [1]. Early identification of the prognostic risk factors of stroke is crucial for risk-specific prevention. Serum aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AAR) has previously been accepted as a strong and independent outcome predictor for cardiovascular diseases (CVD) [2]. It could be useful to identify high- and low-risk patients for targeted prevention of adverse clinical outcomes, such as cardiovascular mortality [3], heart failure [4] and critical limb ischemia [5]. To date, although abundant evidence reported that elevated AAR was associated with poor outcomes of CVD, very few studies explored the prognostic role of AAR on ischemic stroke. AAR was highly elevated in AIS patients [6], being an effective surrogate marker of hepatic-related diseases, including NAFLD, alcohol fatty liver and liver fibrosis [7]. Considering these diseases are known risk factors for diagnosis and predicting outcomes of CVD [8,9], higher AAR may be related to poor outcomes in AIS patients. Gao F, et al reported that an increased AAR at admission was significantly associated with a poor functional outcome at 3 months after AIS [10]. However, the data regarding the AAR and mortality and long-term functional outcome after AIS is not yet sufficiently elucidated. In this study, we aimed to estimate the association between AAR and clinical outcomes after AIS or transient ischemic attack (TIA), including all-cause mortality, poor functional outcome, stroke recurrence, and composite vascular events at 3- and 12- months.

Patients with AIS or TIA in the Third China National Stroke Registry (CNSR-III) were divided into four groups by quartiles of AAR, and two groups according to AAR <1 and AAR ≥1. Multivariable Cox regression for all-cause mortality and logistic regression for poor functional outcome (modified Rankin Scale, mRS 3-6/2-6) were adopted to explore the associations between AAR and clinical outcomes at 3 months and 1 year.