Assciation Of Serum 25(OH)D Levels With Infact Volumes And Stroke Severity In Acute Ischemic Stroke

ObjectiveThe level and metabolic regulation of vitamin D are closely related to the development of many diseases.Studies have shown that the deficiency of vitamin D is associated with the increased risk of stroke onset.the relationship between the level of vitamin D and the DWI infarct volume in patients with acute ischemic stroke is not clear at present,meanwhile,We investigate the potential association between levels of vitamin D in the patients and the NIHSS score.The aim of this study is to investigate whether 25-hydroxy vitamin D(25(OH)D)is associated with initial stroke severity and infarct volume,using diffusion-weighted imaging(DWI)in patients with acute ischemic stroke,which might would help to provide a convenient indicator to evaluate infarct volume and severity in acute ischemic stroke.Methods:In this study,the patients who were admitted to The Second Affiliated Hospital of Zhejiang University within 24 hours of acute ischemic stroke(AIS)onset were selected between October 2015 and September 2016.The patients who had received calcium and/or vitamin D therapy in the past 3 months would be excluded from this study.Patients with malignant tumor,survival time less than 24h,renal insufficiency(creatinine>1.5mg/dl),or autoimmune diseases were also excluded.Initial stroke severity was assessed using the NIH Stroke Scale(NIHSS)score.Infarct volume was measured using DWI.Multivariable regression analysis was used to explore whether 25(OH)D was an independent predictor of infarct volume and stroke severity(NIHSS score of?6).Result:Two hundred thirty-five patients met the study criteria.the median age was 64(IQR,56-75 years).The females accounted for 53.2%.The acute ischemic stroke patients were often accompanied with hypertension and diabetes.Vessel occlusive was the main etiology for the stroke patients.The serum 25(OH)D levels of stroke patients were classified into four quartiles as follows:Quartile 1(<11.9ng/ml),Quartile 2(11.9-19.1 ng/ml),Quartile 3(19.2-25.6 ng/ml),and Quartile 4(>25.6ng/ml).The median DWI infarct volumes for the serum 25(OH)D level quartiles(lowest to highest)were 12.35,6.55,2.44,and 1.59ml.Nonparametric Spearman rank correlation revealed a statistically significant negative correlation between serum 25(OH)D level and infarct volume(r=-0.417;P<0.001).the median adjusted DWI in-farct volumes and interquartile range from lowest to highest of the serum 25(OH)D level quartiles were 11.3(IQR,4.9-27.9);9.2(2.0-18.5);5.4(1.2-16.1)and 3.8(1.4-8.1)ml.The multivariate analysis indicated again a statistically significant overall trend toward increased DWI infarct volumes across 25(OH)D quartiles.The infact volumns of patients with 25(OH)D level in Q1 quantile are more than 6 times of those of patients with 25(OH)D in Q4 quantile(OR = 6.22,95%CI:3.02-12.54,P<0.001),The infact volumns of patients with 25(OH)D level in Q2 quantile are more than three times of those of patients with 25(OH)D in Q4 quantile(OR = 3.36,95%CI:1.55-6.92),The infact volumns of patients with 25(OH)D level in Q3 quantile are not significantly different with those of patients with 25(OH)D in Q4 quantile(OR=1.42,95%CI:0.90-2.55).Patients in the lowest serum 25(OH)D level quartile had a higher median National Institutes of Health Stroke Scale score at admission compared with patients in the highest quartiles(14(IQR:10-19)VS 3(2-5);P<0.001).There was a significantly negative correlation between levels of 25(OH)D and NHISS(r=-0.601;P<0.001).The minor stroke 25(OH)D level was higher than that observed in patients with moderate-to-high clinical severity[24.5(IQR:20.1-29.3)ng/ml VS 12.8(IQR:8.5-18.4)ng/ml;P<0.001].In univariate logistic regressionanalysis,we calculated the ORs of 25(OH)D levels as compared with other risk factors.With an unadjusted OR of 0.808(95%CI,0.767-0.852;P<0.001),25(OH)D had a strong association with moderate-to-high clinical severity stroke.25(OH)D remained an independent stroke severity predictor with an adjusted OR of 0.886(95%CI,0.805-0.932).After adjusting for all other significant indictors in univariate logistic regression analysis,The risk of getting moderate-to-high stroke of patients with 25(OH)D level in Q1 quantile are more than 5 times of those of patients with 25(OH)D in Q4 quantil(OR=5.85,95%CI:2.90-11.54,P<0.001).The risk of getting moderate-to-high stroke of patients with 25(OH)D level in Q2 quantile are more than 3 times of those of patients with 25(OH)D in Q4 quantil(OR=3.02,95%CI:1.59-6.34,P<0.05).The risk of getting moderate-to-high stroke of patients with 25(OH)D level in Q3 quantile are not significantly different with those of patients with 25(OH)D in Q4 quantile(OR =1.49,95%CI:0.98-2.98).Conclusion:1.The DWI infarct volume was negatively correlated with the serum vitamin D level in stroke patients.The lower Serum 25(OH)D level,the larger the infarct volume.Reduced Serum 25(OH)D level levels can be used as an independent predictive factor for infarct volume evaluation in these stroke patients.2.Serum 25(OH)D level was negatively correlated with the severity of illness in patients with stroke.The lower Serum 25(OH)D level,the higher the NIHSS score,and the more severe of the stroke.Therefore,Serum 25(OH)D level can be used to assess the severity of stroke,which would be likely to evaluate the severity(assessed by the NIHSS)as a routine indicator in early acute ischemic patients.