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

Journal：CNS Neuroscience & Therapeutics

Publication type: Original Article

IF(IF): 5.5

PMID: PMC10909616 Link To Pubmed Full text Download

The disease burden due to stroke is increasing worldwide and in China.1, 2 Neurological deterioration (ND), whether it occurs hours or weeks after stroke onset, is associated with adverse prognosis and death.3-6 ND may not always reverse during hospitalization and can persist until discharge.7 Therefore, patients with a higher ND risk should be identified and prioritized to improve in-hospital treatment strategy. Specifically, patients with minor stroke may receive less attention than those who exhibit more obvious symptoms of neurological impairment at admission. Several inflammatory cytokines, including high-sensitivity C-reactive protein (hsCRP),8, 9 interleukin (IL)-6,10 and lipoprotein-associated phospholipase A2 (Lp-PLA2),11 have been identified as independent predictive factors for functional worsening in previous studies. However, these studies often did not focus on cases of minor stroke,8, 10, 12-19 failed to exclude the influence of thrombolysis therapy,9, 12, 17, 20 and were constrained by limited sample sizes and types of inflammatory biomarkers.21 Using data from the Third China National Stroke Registry (CNSR-III), a large-scale registry involving the centralized testing of multiple inflammatory biomarkers within 24 h of admission, we meticulously evaluated the associations of inflammatory biomarkers with in-hospital ND in patients with minor stroke who did not undergo reperfusion therapy and assessed the incremental predictive values of these inflammatory biomarkers when added to traditional risk factors.

Data from patients with minor AIS from the Third China National Stroke Registry were analyzed. Inflammatory cytokine levels within 24 h of admission were measured. The primary outcome was in-hospital ND (an increase in National Institutes of Health Stroke Scale score ≥4 from admission to discharge). Associations were evaluated using odds ratios (ORs) and 95% confidence intervals (CIs) derived from logistic regression models. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were used to evaluate incremental predictive values.