| BackgroundStroke is a disease with high incidence,high mortality,high recurrence rate and high economic burden.According to the Global Burden of Disease data reported,stroke is the leading cause of death in China and the second leading cause in the world.It is a major global public health problem.Stroke not only imposes a physical and mental burden on patients,but also imposes a serious economic burden on families and the countries.Stroke is mainly divided into two types:ischemic stroke and hemorrhagic stroke,of which ischemic stroke accounts for more than 70%.Previous studies supported that smoking,alcohol consumption,atrial fibrillation,and hypertension are important prognostic risk factors for ischemic stroke,but these traditional risk factors are not enough to fully explain the occurrence of adverse outcomes after stroke.Therefore,there is an urgent need to find economical and simple prognostic markers for ischemic stroke,so as to screen out the highrisk population at an early stage.Previous studies have found that platelet count and highsensitivity C-reactive protein(hsCRP)play an important role in the development of atherosclerosis and are closely related to the risk of ischemic stroke.However,there is a lack of studies on the relationship between platelet count,hsCRP and their interaction with the prognosis of ischemic stroke in large samples.This was a large-sample,multicenter,prospective cohort study based on the China Antihypertensive Trial in Acute Ischemic Stroke(CATIS)trial.The aim of this study was to investigate the independent and interaction effects of platelet counts and hsCRP on adverse clinical outcomes at 1-year after ischemic stroke.ObjectiveTo investigate the independent and interaction effects of platelet counts and hsCRP levels on the composite outcome of death or major disability,major disability,death,vascular events,death or vascular events,and ordered modified Rankin scale(mRS)scores after 1year of acute ischemic stroke,and to provide scientific basis for high-risk population stratification in patients with ischemic stroke.Subjects and MethodsThis study was based on the CATIS,and we selected participants who completed the collection of platelet counts,hsCRP levels and 1-year follow-up data.Platelet counts and hsCRP were detected by automatic biochemical analyzer and enzyme-linked immunosorbent assay,respectively.The demographic characteristics,disease history,clinical characteristics and stroke subtypes of all subjects were completed at admission,and mRS score,death and cardiovascular events were collected by face-to-face follow-up with themselves or their family members at 1-year after ischemic stroke.Study outcomes included composite outcome of death or major disability(mRS score:3-6),major disability(mRS score:3-5),death(mRS score:6),vascular events,death or vascular events,and ordered mRS scores.Multivariate logistic regression models or Cox proportional hazard models were used to analyze the association of platelet counts and hsCRP levels with the poor prognosis of ischemic stroke,and the odds ratio(OR)/hazard ratio(HR)and 95%confidence interval(CI)were calculated.Multivariate ordinal logistic regression model was used to analyze the relationship between platelet counts and hsCRP levels and mRS Score at 1-year after ischemic stroke.Restricted cubic spline was used to evaluate the dose-response relationship between platelet counts and hsCRP levels and adverse clinical outcomes at 1-year after ischemic stroke.Furthermore,we calculated the integrated discrimination improvement index(IDI)and the net reclassification improvement index(NRI)to assess whether adding biomarkers to the traditional model could increase the predictive value of the acute ischemic stroke prognostic model.After analyzing the relationship of platelet counts and hsCRP level with ischemic stroke separately,we also investigated the interaction between hsCRP level and platelet counts on adverse clinical outcomes at 1 year after acute ischemic stroke.The participants were divided into low hsCRP and high hsCRP subgroups according to the highest quartile of hsCRP in the separate effect study.The relationship between platelet counts at admission and 1-year adverse clinical outcome of ischemic stroke was analyzed in the two subgroups.ResultsAssociation between platelet counts and prognosis of ischemic strokeAfter 1-year follow-up,total of 846 patients had composite outcome of death or maj or disability(622 patients had major disability and 224 patients had death)and 223 patients had vascular events.Multivariate logistic regression models analysis found that compared with the lowest platelet counts group,patients with highest platelet counts group were associated with significantly increased risks of composite outcome of death or major disability(OR:1.37;95%CI:1.09-1.72),major disability(OR:1.29;95%CI:1.01-1.67)at 1 year after ischemic stroke.Multivariable restricted cubic splints showed a dose-response relationship between platelet counts and the risks of composite outcome of death or major disability and major disability at 1 year after ischemic stroke,respectively.Association between hsCRP and prognosis of ischemic strokeDuring 1-year follow-up,total of 753 patients had composite outcome of death or major disability(559 patients had major disability and 194 patients had death)and 191 patients had vascular events.Multivariate logistic regression models or Cox proportional hazards models analysis showed that compared with the lowest hsCRP group,patients with highest hsCRP levels group were associated with significantly increased risks of composite outcome of death or major disability(OR:2.17;95%CI:1.60-2.95),major disability(OR:1.62;95%CI:1.18-2.23),death(OR:3.10;95%CI:1.70-5.65),death or vascular events(OR:1.65;95%CI:1.13-2.41)at 1 year after ischemic stroke.Multivariate restricted cubic spline showed that there was a dose-response relationship between hsCRP levels and the risks of composite outcome of death or major disability,major disability,death,death or vascular events at 1 year after ischemic stroke,respectively.The interaction of platelet counts and hsCRP on the prognosis of ischemic strokehsCRP levels significantly moderated the relationship between platelet counts and composite outcome of death or major disability(P for interaction=0.003),death(P for interaction=0.003),vascular events(P for interaction=0.031),and death or vascular events(P for interaction=0.037)at 1 year after ischemic stroke,indicating an interaction between hsCRP and platelet count on adverse outcomes at 1 year after ischemic stroke.In multivariate logistic regression models or Cox proportional hazards models analysis,compared with the lowest platelet counts group,patients with highest platelet counts group were associated with significantly increased risks of composite outcome of death or major disability(OR:2.53,95%CI:1.51-4.23),death(HR:2.01,95%CI:1.10-3.67)and death or vascular events(HR:1.94,95%CI:1.14-3.29)in the high hsCRP levels group,and adding platelet count to the traditional model can improve the predictive value of the prognostic model for poor outcome at 1 year after stroke.However,in the low hsCRP level group,compared with the lowest platelet count group,in the highest platelet count group were not significantly associated with a composite outcome of death or major disability(OR:1.05,95%CI:0.72-1.51),death(HR:0.54,95%CI:0.25-1.15),death or vascular events(HR:0.86,95%CI:0.53-1.40)were not significantly increased at 1-year after ischemic stroke.Multivariate restricted cubic spline showed that there was a dose-response relationship between platelet counts and the risks of composite outcome of death or major disability,death,death or vascular events in the high hsCRP levels group,but not in the low hsCRP levels group.ConclusionsThere were significantly associations between platelet counts and the risk of composite outcomes of death or major disability,and major disability at 1-year after ischemic stroke.Elevated hsCRP level were associated with the increased risks of death or major disability,major disability,death and death or vascular events at 1-year after ischemic stroke.hsCRP levels significantly moderated the relationship between platelet counts and adverse clinical outcomes at 1-year after ischemic stroke.In patients with high level of hsCRP,elevated platelet counts significantly increased risks of adverse clinical outcomes at 1-year after ischemic stroke,but in those with low levels of hsCRP,platelet counts were not significantly associated with risk of adverse clinical outcomes at 1-year after ischemic stroke. |
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