Correlation Between Peripheral Blood Inflammatory Indicators And Post-stroke Cognitive Impairment In Patients With Acute Ischaemic Stroke

Objectives:To investigate the correlation between peripheral blood inflammatory markers（neutrophil percentage,NLR and PNR）and the development and severity of PSCI in patients with mild AIS,and to gain a deeper understanding of the pathogenesis of PSCI for better screening and treatment of patients with PSCI.Methods:A total of 454 patients with mild AIS who were admitted to the Department of Neurology of the First Hospital of Baiqiu’en,Jilin University,from April 2019 to October 2021 were selected to collect general clinical data,routine laboratory tests on admission,neuropsychological scores and imaging data.The patients were divided into PSCI and PSNCI groups according to the MOCA score;the PSCI patients were further divided into PSCIND and PSD groups according to the MMSE score.The clinical data and peripheral blood inflammatory indexes were analysed for differences between the different groups.Binary logistic regression was used to analyse the independent factors influencing the occurrence of PSCI;ROC curves were used to analyse the predictive value of single inflammatory indexes and models containing different inflammatory indexes for PSCI.Results:1.A total of 454 patients with mild AIS were included in this study,including253（55.7%）in the PSCI group,326（71.8%）males,with a mean age of 62.15 ± 7.34 years and a median education level of 9 years.Patients were divided by MOCA and MMSE scores into 201（44.3%）in the PSCI group,135（29.7%）in the PSCIND group and 118（26%）in the PSD group.2.Between the PSCI and PSNCI groups,univariate analysis showed that the percentage of neutrophils,percentage of lymphocytes,absolute lymphocyte values,NLR,PNR and NLR quintile,history of hypertension,history of previous stroke,site（anterior and posterior circulation）and number of infarcts,age,education,systolic blood pressure,NIHSS score,DMTS,DWMH,uric acid The differences were statistically significant（P < 0.05）.3.The differences between the PSNCI,PSCIND and PSD groups at the acute AIS stage were statistically significant（P < 0.05）in terms of neutrophil percentage,lymphocyte percentage,NLR and NLR quintile;the differences were not significant in terms of CRP,WBC,absolute neutrophil value,absolute lymphocyte value,PLT,PLR,PNR and PNR quintile.4.Multifactorial analysis of the occurrence of PSCI（1）In the multifactorial analysis that included neutrophil percentage and lymphocyte percentage,age,education level,anterior circulation infarction,history of previous hypertension,history of stroke,NIHSS score,DMTS,and percentage of neutrophils were all independent influencing factors for the occurrence of PSCI.（2）Age,educational level,history of previous stroke,DMTS,uric acid,and PNR were independent influences on the occurrence of PSCI in the multifactorial analysis that included PNR.（3）In the multifactorial analysis including NLR quintiles,age,educational level,history of previous stroke,DMTS,anterior circulation cerebral infarction,and NLR as a rank variable were all independent influences on the occurrence of PSCI.5.The sensitivity and specificity of single inflammatory indicators for predicting PSCI were relatively low,but when combined with age,educational level,previous stroke history and DMTS,the area under the curve and the sensitivity and specificity of each diagnostic model increased substantially.Conclusions:1.Neutrophil percentage,NLR and PNR,all of which are peripheral blood inflammatory indicators,are independent influences on the development of PSCI in the acute phase in patients with AIS,with neutrophil percentage and NLR as rank variables being independent risk factors for PSCI and PNR as a continuous numerical type variable being an independent protective factor for PSCI.2.Neutrophil percentage,lymphocyte percentage,NLR,and NLR quintile are also influential factors for different levels of cognition,especially between PSNCI and PSD groups with significant differences in the above inflammatory indicators.3.A single peripheral blood inflammatory index can be combined with age,educational level,previous stroke history and DMTS to improve the diagnostic value of PSCI.