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Integrating Inflammation and Lipid Metabolism Biomarkers for Early Risk Stratification in Acute Cerebral Infarction:
Mei Ding1, Jie Dai1, Zhiyong Cao1
1Department of Neurology, Nantong First People's Hospital, Nantong, Jiangsu, China, nt2191.com.
Insights
Biomarkers like the homocysteine-to-HDL cholesterol (Hcy/HDL-C) and hs-CRP-to-albumin (hs-CRP/Alb) ratios predict poor outcomes in acute cerebral infarction (ACI) patients after rt-PA treatment. A nomogram using these ratios improves prognostic accuracy for personalized risk assessment.
Area of Science:
- Neurology
- Biomarkers
- Cardiovascular Research
Background:
- Acute cerebral infarction (ACI) poses significant disability risks.
- Predicting functional outcomes post-thrombolysis is crucial for patient management.
- Novel biomarkers are needed to enhance prognostic accuracy.
Purpose of the Study:
- To evaluate the prognostic value of Hcy/HDL-C and hs-CRP/Alb ratios in ACI patients receiving rt-PA.
- To develop and validate a predictive nomogram for functional outcomes.
Main Methods:
- Retrospective analysis of 204 ACI patients treated with rt-PA.
- Classification of patients based on 3-month modified Rankin Scale (mRS) scores.
- Logistic regression, restricted cubic spline analysis, and nomogram development incorporating Hcy/HDL-C, hs-CRP/Alb, NIHSS, and atrial fibrillation.
Main Results:
- Elevated Hcy/HDL-C and hs-CRP/Alb ratios independently predicted poor functional outcomes (p < 0.05).
- The developed nomogram achieved high predictive performance (C-index=0.936, AUC=0.935), outperforming traditional models.
- Hcy/HDL-C was more predictive in large-artery atherosclerosis, while hs-CRP/Alb was more predictive in cardioembolic stroke subtypes.
Conclusions:
- Hcy/HDL-C and hs-CRP/Alb ratios are valuable independent predictors of poor outcomes in ACI patients post-rt-PA.
- The nomogram offers superior prognostic accuracy for personalized risk assessment and management.
- These biomarkers aid in optimizing thrombolytic therapy strategies.
Objective:
To assess the prognostic value of the homocysteine-to-high-density lipoprotein cholesterol (Hcy/HDL-C) ratio and the high-sensitivity C-reactive protein-to-albumin (hs-CRP/Alb) ratio as biomarkers for predicting functional outcomes in acute cerebral infarction (ACI) patients treated with recombinant tissue plasminogen activator (rt-PA).
Methods:
A retrospective analysis was conducted on 204 ACI patients who received rt-PA. Patients were classified into two groups based on their functional outcomes at 3 months poststroke: good (modified Rankin scale [mRS] ≤ 2) and poor (mRS > 2). Logistic regression and restricted cubic spline (RCS) analyses were performed to evaluate the association between Hcy/HDL-C and hs-CRP/Alb ratios with functional outcomes. A predictive nomogram was developed incorporating these biomarkers, baseline NIHSS scores, and atrial fibrillation. The performance of this nomogram was compared to traditional risk models.
Results:
Elevated Hcy/HDL-C and hs-CRP/Alb ratios were identified as independent predictors of poor functional outcomes in ACI patients (p < 0.05). The nomogram, incorporating these biomarkers along with NIHSS scores and atrial fibrillation, demonstrated superior predictive performance with a C-index of 0.936 and an AUC of 0.935, outperforming traditional risk models (C-index = 0.782). Subgroup analysis revealed that Hcy/HDL-C was more predictive in patients with large-artery atherosclerosis (LAA), while hs-CRP/Alb showed stronger prognostic value in patients with cardioembolic strokes.
Conclusion:
The Hcy/HDL-C and hs-CRP/Alb ratios serve as independent and valuable biomarkers for predicting poor outcomes in ACI patients post-rt-PA treatment. The nomogram incorporating these biomarkers provides superior prognostic accuracy and could be a useful tool for personalized risk assessment and management in ACI patients following thrombolytic therapy.
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