Association Of Serum Vitamin D Levels With Prognosis In Ischemic Stroke Patients Receiving Intravenous Thrombolytic Therapy

Background Acute Ischemic Stroke(AIS)is a group of clinical syndromes caused by various causes of blood supply disorders in brain tissue,resulting in ischemic and hypoxic changes,and then neurological dysfunction.It is the most common type of stroke and the leading cause of death and disability in adults in China.And the incidence is increasing year by year.Intravenous Thrombolysis(IVT)is one of the most effective early treatments for AIS patients.However,there are still many patients with poor prognosis after IVT treatment.In recent years,great attention has been paid to the identification of new therapeutic targets,especially in biomarkers,which are of great significance to explore the influencing factors of the severity of neurological deficits and clinical outcomes in AIS patients at admission,and to improve patient prognosis and predict clinical outcomes.The traditional view is that vitamin D mainly plays a major role in bone calcium and phosphorus metabolism.In recent years,the role of vitamin D in ischemic stroke has been gradually recognized.Many studies have found that serum vitamin D levels may be related to the occurrence of ischemic stroke,neurological deficit at admission,stroke progression and clinical functional outcome,and vitamin D deficiency may be one of the risk factors for ischemic stroke.About 1billion people worldwide are vitamin D deficient,which can be detrimental to the prognosis of various diseases,including stroke.However,there is a lack of studies evaluating the association between serum vitamin D levels and AIS patients treated with IVT.Therefore,this study explored the correlation between serum vitamin D level and the severity of neurological deficit at admission and 3-month clinical outcome in AIS patients treated with IVT,so as to provide new ideas for the treatment of ischemic stroke.Objective To investigate the relationship between serum 25-hydroxyvitamin D [25(OH)D] levels and the severity of neurological deficit at admission and clinical outcome at 3 months in AIS patients treated with IVT.Methods The clinical data and laboratory indexes of AIS patients who received IVT treatment in the Second People’s Hospital of Hefei from February 2020 to June 2022 were collected.The patients were divided into vitamin D deficiency group and non-vitamin D deficiency group according to whether the fasting serum 25(OH)D level was < 20 ng/ml within 24 hours after thrombolysis.According to whether the National Institutes of Health Stroke scale Score(NIHSS)was < 5 at admission,the patients were divided into mild stroke and moderate to severe stroke.According to the modified Rankin Scale(m RS)score at 3 months after onset,m RS Score < 3 was defined as good outcome,and m RS Score ≥ 3 was defined as poor outcome.Multivariate logistic regression analysis was used to determine the independent influencing factors of neurological deficit severity at admission and clinical outcome at3 months.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of 25(OH)D level for poor clinical outcome at 3 months.Results A total of 177 AIS patients treated with IVT were enrolled in this study,including 57 patients with mild stroke and 120 patients with moderate to severe stroke at admission.At 3 months,112 patients had a good clinical outcome,and 65 patients had a poor outcome.Multivariate logistic regression analysis showed that the 25(OH)D level in AIS patients treated with IVT was associated with the risk of moderate to severe stroke at admission(OR=0.91,95%CI: 0.86-0.96,P=0.001)and the risk of poor outcome at 3 months(OR=0.83,95%CI: 0.77-0.90,P < 0.001).Patients with vitamin D deficiency had a significantly higher risk of moderate to severe stroke than those without vitamin D deficiency(OR=5.47,95%CI: 2.07-14.43,P=0.001).The risk of poor outcome in vitamin D deficiency group was significantly higher than that in non-vitamin D deficiency group(OR=18.52,95%CI: 6.29-54.53,P < 0.001).ROC curve analysis showed that the area under the curve(AUC)of 25(OH)D level in patients receiving IVT for predicting poor clinical outcomes at 3 months was 0.737(95%CI: 0.66-0.82,P < 0.001).The optimal cut-off value was 19.50,and the sensitivity and specificity were 58.5% and 86.6%,respectively.Conclusion In AIS patients treated with IVT,the fasting serum 25(OH)D level within 24 hours after thrombolysis is associated with the severity of neurological deficit at admission and clinical outcome at 3 months.It is a protective factor for poor clinical outcome at 3 months,and 25(OH)D level has predictive value for poor clinical outcome at 3 months.