Related Factors Of Early Neurological Deterioration In Acute Ischemic Stroke Patients With Rt PA Thrombolysis

Objective: To find the possible indicators of early neurological deterioration(END)in patients with acute cerebral infarction after intravenous thrombolytic therapy.Methods: For nine years from the first month of 2010 to the end of 2018,we collect the information of patients with acute cerebral infarction in the First Affiliated Hospital,School of Medicine,Shihezi University.The patients were treated by intravenous thrombolytic therapy with atepase during 4.5 hours of onset.The information include the patient’s basic history and baseline vital signs,biochemical data and other indicators.The patients were evaluated before and 72 h after intravenous thrombolytic therapy,and the patients were divided into END group and non END group according to the criterion.According to the severity of stroke,patients were divided into three subgroups: mild stroke(0-5),moderate stroke(5-15)and severe stroke(>15).The END related factors of mild stroke patients were analyzed separately.Logistic regression was used to analyze the data of the related factors with END occurrence,.Then the Receiver operator characteristic(ROC)was selected to evaluate the relationship between these related indexes and END after intravenous thrombolysis in stroke patients.Results: Of the 422 patients receiving intravenous therapy,we pick up 346 patients who met the criteria.END occurred in 11.27%(39/346)of the patients.In this study,we found a significant correlation between END and neutrophil count(P<0.001),admission NIHSS(P=0.009),C reactive protein(P=0.035),blood glucose level(P=0.002),neutrophil to lymphocyte ratio(P<0.001).In addition,Regression analysis showed that neutrophil was independent risk factors for END(OR=1.215,95%CI,1.019-1.450;P=0.03).ROC results show that the optimum cut-off value was 5.01×10^9/ L and sensitivity was 84.6% and specificity was 51.5% and area under curve was 0.715(95%CI,0.635-0.795;P<0.001).The regression analysis found5.01×10^9/L or more count of neutrophil(OR5.832;95%CI 2.375-14.319,P<0.001)was related to higher END rates.Among the162 patients with mild stroke,24 are in END group and 138 cases are in the non END group.In mild stroke patients,compared with the END group,END group had higher cystatin C,creatinine,homocysteine,C reactive protein and blood glucose.In addition,The Independent correlation between elevated cystatin C and END was showed(OR=7.502,CI,95 per cent 1.500-37.519;P=0.014).The study spreading out into two teams in the light of cystatin C =0.975mg/l.The risk of END in the higher cystatin C group was increased relative to other group(OR=3.946,95%CI,1.372-11.346;P=0.011)。.Conclusions: This study suggests that neutrophil count could be a serviceable indicator for forecasting END.When it is greater than 5.01×10^9/L,the higher risk of END appeared in patients with rt PA.In mild stroke patients,High levels of cystatin C suggest poor neurological recovery and poor prognosis.