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      Pan-Immune-Inflammatory Value Predicts the 3 Months Outcome in Acute Ischemic Stroke Patients after Intravenous Thrombolysis

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          Abstract

          Background and Purpose

          Immune and inflammatory response plays a central role in the clinical outcomes of stroke. This study is aimed to explore the clinical significance of the new inflammation index named pan-immune-inflammation value (PIV) in patients with acute ischemic stroke (AIS) after intravenous thrombolysis therapy (IVT).

          Methods

          Data were collected from 717 patients who received IVT at the First Affiliated Hospital of Soochow University. Baseline data were collected before intravenous thrombolysis. Multivariate logistic regression analysis was used to assess the association between PIV and 3 months clinical outcome after intravenous thrombolysis. We also used receiver operating characteristic (ROC) curves analysis to assess the discriminative ability of PIV, platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), and systemic immune-inflammation index (SII) in predicting 3 months poor outcome.

          Results

          Of 717 patients, 182 (25.4%) patients had poor outcomes at 3 months. Patients with 3 months of poor outcome had significantly higher PIV levels compared to those with favorable outcomes [316.32 (187.42-585.67) vs. 223.80 (131.76-394.97), p < 0.001)]. After adjusting for potential confounders, the risk of 3 months of poor outcome was significantly higher among patients whose PIV fell in the third quartile (244.21-434.49) and the fourth quartile (> 434.49) than those in the first quartile (< 139.93) (OR = 1.905, 95% CI: 1.040-3.489; OR = 2.229, 95%CI: 1.229-4.044). The area under the ROC curve of PIV to predict 3 months of poor outcome was 0.607 (95%CI: 0.560-0.654; p < 0.001). The optimal cut-off values of PIV were 283.84 (59% sensitivity and 62% specificity).

          Conclusion

          The higher levels of PIV were independently associated with 3 months of poor outcomes in AIS patients receiving IVT. PIV like other inflammatory factors (PLR, NLR, and SII), can also predict adverse outcomes after IVT in AIS patients.

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          Most cited references29

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          Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

          Fakher Rahim, Yasir Waheed (2022)
          Summary Background Regularly updated data on stroke and its pathological types, including data on their incidence, prevalence, mortality, disability, risk factors, and epidemiological trends, are important for evidence-based stroke care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) aims to provide a standardised and comprehensive measurement of these metrics at global, regional, and national levels. Methods We applied GBD 2019 analytical tools to calculate stroke incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and the population attributable fraction (PAF) of DALYs (with corresponding 95% uncertainty intervals [UIs]) associated with 19 risk factors, for 204 countries and territories from 1990 to 2019. These estimates were provided for ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, and all strokes combined, and stratified by sex, age group, and World Bank country income level. Findings In 2019, there were 12·2 million (95% UI 11·0–13·6) incident cases of stroke, 101 million (93·2–111) prevalent cases of stroke, 143 million (133–153) DALYs due to stroke, and 6·55 million (6·00–7·02) deaths from stroke. Globally, stroke remained the second-leading cause of death (11·6% [10·8–12·2] of total deaths) and the third-leading cause of death and disability combined (5·7% [5·1–6·2] of total DALYs) in 2019. From 1990 to 2019, the absolute number of incident strokes increased by 70·0% (67·0–73·0), prevalent strokes increased by 85·0% (83·0–88·0), deaths from stroke increased by 43·0% (31·0–55·0), and DALYs due to stroke increased by 32·0% (22·0–42·0). During the same period, age-standardised rates of stroke incidence decreased by 17·0% (15·0–18·0), mortality decreased by 36·0% (31·0–42·0), prevalence decreased by 6·0% (5·0–7·0), and DALYs decreased by 36·0% (31·0–42·0). However, among people younger than 70 years, prevalence rates increased by 22·0% (21·0–24·0) and incidence rates increased by 15·0% (12·0–18·0). In 2019, the age-standardised stroke-related mortality rate was 3·6 (3·5–3·8) times higher in the World Bank low-income group than in the World Bank high-income group, and the age-standardised stroke-related DALY rate was 3·7 (3·5–3·9) times higher in the low-income group than the high-income group. Ischaemic stroke constituted 62·4% of all incident strokes in 2019 (7·63 million [6·57–8·96]), while intracerebral haemorrhage constituted 27·9% (3·41 million [2·97–3·91]) and subarachnoid haemorrhage constituted 9·7% (1·18 million [1·01–1·39]). In 2019, the five leading risk factors for stroke were high systolic blood pressure (contributing to 79·6 million [67·7–90·8] DALYs or 55·5% [48·2–62·0] of total stroke DALYs), high body-mass index (34·9 million [22·3–48·6] DALYs or 24·3% [15·7–33·2]), high fasting plasma glucose (28·9 million [19·8–41·5] DALYs or 20·2% [13·8–29·1]), ambient particulate matter pollution (28·7 million [23·4–33·4] DALYs or 20·1% [16·6–23·0]), and smoking (25·3 million [22·6–28·2] DALYs or 17·6% [16·4–19·0]). Interpretation The annual number of strokes and deaths due to stroke increased substantially from 1990 to 2019, despite substantial reductions in age-standardised rates, particularly among people older than 70 years. The highest age-standardised stroke-related mortality and DALY rates were in the World Bank low-income group. The fastest-growing risk factor for stroke between 1990 and 2019 was high body-mass index. Without urgent implementation of effective primary prevention strategies, the stroke burden will probably continue to grow across the world, particularly in low-income countries. Funding Bill & Melinda Gates Foundation.
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            Global Burden of Stroke.

            Bo Norrving, George Mensah, Valery L. Feigin (2017)
            On the basis of the GBD (Global Burden of Disease) 2013 Study, this article provides an overview of the global, regional, and country-specific burden of stroke by sex and age groups, including trends in stroke burden from 1990 to 2013, and outlines recommended measures to reduce stroke burden. It shows that although stroke incidence, prevalence, mortality, and disability-adjusted life-years rates tend to decline from 1990 to 2013, the overall stroke burden in terms of absolute number of people affected by, or who remained disabled from, stroke has increased across the globe in both men and women of all ages. This provides a strong argument that "business as usual" for primary stroke prevention is not sufficiently effective. Although prevention of stroke is a complex medical and political issue, there is strong evidence that substantial prevention of stroke is feasible in practice. The need to scale-up the primary prevention actions is urgent.
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              Dyslipidemia

              Laurie Kopin, Charles J. Lowenstein (2017)
              Dyslipidemia is an important risk factor for coronary artery disease and stroke. Long-term, prospective epidemiologic studies have consistently shown that persons with healthier lifestyles and fewer risk factors for coronary heart disease, and particularly those with favorable lipid profiles, have reduced incidence of coronary heart disease. Prevention and sensible management of dyslipidemia can markedly alter cardiovascular morbidity and mortality.
              Article 0 comments Cited 201 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (publisher-id): CNR
                Journal ID (nlm-ta): Curr. Neurovasc. Res.
                Title: Current Neurovascular Research
                Abbreviated Title: Curr. Neurovasc. Res.
                Publisher: Bentham Science Publishers
                ISSN (Print): 1567-2026
                ISSN (Electronic): 1875-5739
                Publication date (Electronic): 2023
                Volume: 20
                Issue: 4
                Pages: 464-471
                Affiliations
                [1 ] deptDepartment of Neurology , The First Affiliated Hospital of Soochow University , Suzhou, , China;
                [2 ] deptDepartment of General Medicine , The First Affiliated Hospital of Soochow University , Suzhou, , China;
                [3 ] deptDepartment of Neurology , Dushu Lake Hospital Affiliated to Soochow University , Suzhou, , China;
                [4 ] deptDepartment of Emergency , The First Affiliated Hospital of Soochow University , Suzhou, , China
                Author notes
                [* ]Address correspondence to these authors at the Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China; Department of Neurology, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, China; Department of Emergency, The First Affiliated Hospital of Soochow University, Suzhou, China; Tels: 13606213892 and 13771800776; E-mails: fangqi_008@ 123456126.com ; 121752769@ 123456qq.com
                [# ] These authors contributed equally to this work.
                Article
                Publisher ID: CNR-20-4-464
                DOI: 10.2174/0115672026276427231024045957
                PMC ID: 10825792
                PubMed ID: 37921190
                SO-VID: 7038dffc-bc54-48c9-a10c-7417d5612ece
                Copyright statement: Copyright @ 2023
                License:

                This is an Open Access article published under CC BY 4.0 https://creativecommons.org/licenses/by/4.0/legalcode

                History
                Date received : 08 August 2023
                Date revision received : 09 September 2023
                Date accepted : 12 September 2023
                Categories
                Subject: Medicine, Neurology, Neurosciences

                ScienceOpen disciplines: Medicine,Chemistry,Life sciences
                Keywords: multivariate logistic regression analysis,intravenous thrombolysis,new inflammation index,acute ischemic stroke,Pan-immune-inflammation value,clinical outcome
                Data availability:
                ScienceOpen disciplines: Medicine, Chemistry, Life sciences
                Keywords: multivariate logistic regression analysis, intravenous thrombolysis, new inflammation index, acute ischemic stroke, Pan-immune-inflammation value, clinical outcome

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