| BackgroudIschemic stroke is a dominant cause of disability and mortality globally,and imposes an enormous economic burden on society.Although the pathogenic mechanism has been widely studied,the therapeutic strategies for treating acute ischemic stroke(AIS)are still lacking.Vascular recanalization therapy,such as intravenous thrombolysis(IVT)and endovascular thrombectomy(EVT),is the principal treatment for AIS.However,the limited benefit of IVT is likely associated with the narrow therapeutic time window of 3-4.5h after stroke and the low recanalization rate of around 20%in patients with large vessel occlusion.And even after EVT with high recanalization rate,more than half of them still die or suffer from a disability.Therefore,the treatment of AIS still remains a great challenge.The study of the factors influencing functional outcome of patients with AIS can contribute to predicting the risk of unfavorable outcomes and provide new ideas for the treatment of AIS by effective intervention of controllable risk factors.This study was designed to analyze the factors influencing functional outcome of patients with AIS and evaluate the risk of poor prognosis.Materials and methodsThe study was a prospective observational clinical study.From September 2019 to January 2021,we consecutively recruited patients hospitalized for acute ischemic stroke at our stroke center.The clinical,radiologistic and laboratory data of all enrolled patients were evaluated at baseline and follow-up of 3 month.The serum levels of vascular endothelial growth factor(VEGF)of AIS patients at admission and day 7 was measured by enzyme linked immunosorbent assay(ELISA).The primary outcome was evaluated with mRS scores at 3 months.Poor prognosis was defined as mRS≤2,while good prognosis was defined as a mRS>2.Expectation maximization(EM)were used for imputation of missing data.Univariate logistic regression analysis was performed to screen out the significant variables.Any variable on univariate analysis with P<0.05 was included in multivariate logistic regression analysis.We assessed multicollinearity using tolerance and variance inflation factor(VIF).We plotted a receiver operating characteristic(ROC)curve to evaluate the predictive performance of the regression model.ResultsA total of 125 eligible patients were analyzed.Univariate logistic regression analysis showed thirteen variables may influence the poor prognosis of patients with AIS i.e.,age,diabetes,atrial fibrillation,lymphocyte count,FT3,HbA1c,the concentration of VEGF at day 7,Essen Stroke Risk Score,ASPECTS at admission,NIHSS at admission,NIHSS at day 3,NIHSS at day 14,large-artery atherosclerosis(TOAST classification).We found no collinearity among the above variables.The value of tolerance of each variable is great than 0.1,and the value of VIF of each variable is less than 10.Multivariate logistic regression analysis suggested HbA1c(OR=1.73 6,95%CI:1.214-2.484,P=0.003),FT3(OR=0.431,95%CI:0.186-0.997,P=0.049),ASPECTS at admission(OR=0.658,95%CI:0.466-0.930,P 0.018),NIHSS at day 14(OR=1.723,95%CI:1.323-2.244,P<0.001)as the predictive factor of 3-month poor prognosis of AIS patients.Area under the receiver operating characteristics curve(AUC)is 0.921(95%CI:0.875-0.967).ConclusionHbAlc,FT3,ASPECTS at admission,and NIHSS at day 14 are associated with the 3-month poor outcome of AIS patients.Patients with poor prognosis showed a significantly higher level of VEGF compared with those with good prognosis. |
