The Relationship Between Fibrinogen Level And Adverse Outcome Among Patients With Acute Ischemic Stroke

Objectives:To explore the relationship between fibrinogen level and adverse outcome among patients with acute ischemic stroke.Subjects and Methods:Subjects: From May 31, 2009 to May 31, 2013 in affiliated Hospital of Chengde Medical College Department of internal medicine and confirmed by head CT or MRI confirmed the diagnosis of acute ischemic stroke patients as the research object, included in the study sample size of 1984 patients.Method: Using the research methods of retrospective cohort, we collected the admission, during hospitalization and discharge outcomes related to data in accordance with this study of patient and detailed data entry, filling in the unified design of the questionnaire of case.We evaluated the outcome by Modified Rankin’s scale in all patients, the outcome was completed by neural Department of internal medicine attending doctor. When the patients discharged alive, for their self-care scores, if MRs is larger than or equal to 3 specific definitions for disability; when the patients at the time of death,MRs score was 6. We defined the patients of good outcome(MRs:0, 1and 2) and the poor outcomes(MRs:3, 4 and 5 of the disability and death of MRs=6).Statistical analysis: Epi Data3.1 software was used to establish the database, and all questionnaires date were recorded after checked by two individuals. Professionals can acess to the original questionnaire to resive and re-intry the data if the data errors of different,and establish the final database.We defined the good outcome(MRs:0, 1 and 2)and the poor outcomes(MRs : 3, 4 and 5 of the disability and death of MRs=6). Continuousdata consistent with the use of t test of normal distribution, which belongs to the skewed distribution for non-parameter test; count data were compared using the chi-square test in comparison of the general situation of the good outcome group and the poor outcome group.The single factor and multiple factor non-conditional Logistic regression analysis were used to analysis of the risk factors for poor outcome. According to the fibrinogen level in the determination of admission of patients, given quartile( ≤ 2.4g/L, 2.4~2.72g/L,2.72~3.18g/L,>3.18g/L).The first subgroup(≤2.4g/L) as the refe-rence group of four groups, 2,3,4 group is calculated with respect to the first subgroup of adverse outcome odds ratio(OR) and 95% confidence interval(95%CI). Statistical analysis of the data processing is completed by the SAS9.2 software, and two-sided test with P<0.05 said the difference had statistical significance.Results:1 Comparison of the general situation of patient with acute ischemic stroke at different discharge outcomes. We found to compared the poor outcome of group of patients with good outcome of patients,meaning age of patients were older, hospitalization time was longer, meanwhile occur-admission time was shorter, the admission NIHSS score was higher,the starting ischemic stroke was less,the temperature was slightly higher, the history of heart disease and atrial fibrillation were higher prevalence rate,the levels of blood glucose fibrinogen were higher(P <0.05).2 According to the fibrinogen level in the determination of admission of patients, given quartile( ≤ 2.4g/L, 2.4 ~ 2.72 g/L, 2.72 ~ 3.18g/L,> 3.18g/L).we found that the number and percentage of the adverse outcomes are different in each level group,and 1~4 groups of adverse outcomes occurred in24.25%, 29.67%, 33%, 37.22%, were compared with the group of low fibrinogen level, the occurrence rate of bad outcomes is higher in the groupof higher fibrinogen level(P <0.05).3 The single factor non-conditional logistic regression analysis of patients with acute ischemic stroke factors of adverse outcomes showed that theage, duration of hospitalization, NIHSS scores on admission, history of atrial fibrillation,high blood glucose,fibrinogen are risk factors of poor outcome,its OR(95% CI) were 1.119(1.036~1.210), 1.591(1.233~2.052), 1.588(1.520~1.659),1.920(1.377~2.873),1.522(1.254~1.848),1.252(1.133 ~1.384).And the starting ischemic stroke,drinking, triglycerides are protective factors for poor outcome, its OR(95% CI) were 0.700(0.577~0.849), 0.827(0.688~ 0.995),0.905(0.826~ 0.990).4 The single factor non-conditional logistic regression analysis of fibrinogen levels in patients with acute ischemic stroke factors of adverse outcomes,based on fibrinogen levels measured in patients admitted to hospital, given quartile( ≤ 2.4g/L,2.4~2.72g/L,2.72~3.18g/L,>3.18g/L), the results show that compared with the lowest subgroup(2.4g/L group), and the third and fourth point group occurred adverse of OR(95%CI) were 1.518(1.150~2.004),1.896(1.442 ~ 2.494)(P <0.05).5 The multiple factor non-conditional logistic regression analysis of fibrinogen levels in patients with acute ischemic stroke factors of adverse outcomes,based on fibrinogen levels measured in patients admitted to hospital,given quartile(≤2.4g/L,2.4~2.72g/L,2.72~3.18g/L,>3.18g/L), the results show that compared with the lowest subgroup(2.4g/L) and different fibrinogen level groups no relevance of poor cotcome,which under the multiple factor adjustment with NIHSS scores on admission.When correction of hospitalize-tion NIHSS removed, the result of multiple factor adjustment for analysis showed that compared with the lowest subgroup(2.4g/L),and the third and fourth point group occurred adverse outcomes of OR(95%CI) were 1.459(1.099 ~ 1.937), 1.683(1.271 ~ 2.230)(P<0.05).Conclusion:The fibrinogen level in the patients with acute ischemic independently related with occurred adverse outcome and higher levels of fibrinogen is harmful to stroke short-term outcome.