Background

Inflammation plays a prominent role in the pathogenesis and progression of acute ischemic stroke (AIS). The red blood cell distribution width to platelet ratio (RPR) has been demonstrated as a novel biomarker to indicate the severity of inflammatory reaction. This study aimed to explore the association between RPR before intravenous thrombolysis and early neurological deterioration (END) after thrombolysis in AIS patients.

Methods

AIS patients accepting intravenous thrombolysis were recruited continuously. Postthrombolysis END was defined as death or an increase in the National Institute of Health Stroke Scale (NIHSS) score ≥4 points within 24 h after intravenous thrombolysis compared to the NIHSS score before intravenous thrombolysis. We constructed univariate and multivariate logistic regression analyses to investigate the relationship of RPR before intravenous thrombolysis to postthrombolysis END. Moreover, a receiver operating characteristic (ROC) curve was applied to examine the discriminative utility of RPR before intravenous thrombolysis in predicting postthrombolysis END.

Results

A total of 235 AIS patients were included, and 31 (13.19%) subjects underwent postthrombolysis END. The univariate logistic regression analysis demonstrated that RPR before intravenous thrombolysis was significantly related to postthrombolysis END (odds ratio [OR], 2.162; 95% confidence interval [CI], 1.605-2.912; P < 0.001). After adjusting for potential confounding variables with P < 0.15 in the univariate logistic regression analysis, the difference remained statistically significant (OR, 2.031; 95% CI, 1.436-2.873; P < 0.001). Furthermore, an optimal cutoff value of 7.66 for RPR before intravenous thrombolysis in predicting postthrombolysis END was observed in the ROC curve analysis, and the sensitivity and specificity were calculated as 61.3% and 81.9%, respectively (area under the curve [AUC], 0.772; 95% CI, 0.684-0.860; P < 0.001).

Conclusions

RPR before intravenous thrombolysis might be an independent risk factor for postthrombolysis END in AIS patients. Elevated levels of RPR before intravenous thrombolysis may predict postthrombolysis END.

中文翻译：

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红细胞分布宽度与血小板比率预测接受静脉溶栓治疗的急性缺血性卒中患者的早期神经功能恶化

背景

炎症在急性缺血性卒中 (AIS) 的发病机制和进展中起着重要作用。红细胞分布宽度与血小板比率 (RPR) 已被证明是一种新型生物标志物，可指示炎症反应的严重程度。本研究旨在探讨 AIS 患者静脉溶栓前 RPR 与溶栓后早期神经功能恶化 (END) 之间的关系。

方法

持续招募接受静脉溶栓治疗的 AIS 患者。溶栓后 END 定义为死亡或与静脉溶栓前的 NIHSS 评分相比，静脉溶栓后 24 小时内美国国立卫生研究院卒中量表 (NIHSS) 评分增加≥4 分。我们构建了单变量和多变量逻辑回归分析来研究静脉溶栓前 RPR 与溶栓后 END 的关系。此外，应用接受者操作特征 (ROC) 曲线来检查静脉溶栓前 RPR 在预测溶栓后 END 方面的鉴别效用。

结果

共纳入 235 名 AIS 患者，其中 31 名 (13.19%) 受试者接受了溶栓后 END。单因素逻辑回归分析表明，静脉溶栓前 RPR 与溶栓后 END 显着相关（比值比 [OR]，2.162；95% 置信区间 [CI]，1.605-2.912；P < 0.001 ）  。在单变量逻辑回归分析中调整P  < 0.15 的潜在混杂变量后，差异仍然具有统计学意义（OR，2.031；95% CI，1.436-2.873；P < 0.001)。此外，在 ROC 曲线分析中观察到静脉溶栓前 RPR 预测溶栓后 END 的最佳截断值为 7.66，计算得出的敏感性和特异性分别为 61.3% 和 81.9%（曲线下面积 [AUC]，0.772 ；95% CI，0.684-0.860；P  < 0.001）。

结论

静脉溶栓前 RPR 可能是 AIS 患者溶栓后 END 的独立危险因素。静脉溶栓前 RPR 水平升高可预测溶栓后 END。