Procalcitonin Is a Stronger Predictor of Long-Term Functional Outcome and Mortality than High-Sensitivity C-Reactive Protein in Patients with Ischemic Stroke
Procalcitonin Is a Stronger Predictor of Long-Term Functional Outcome and Mortality than High-Sensitivity C-Reactive Protein in Patients with Ischemic Stroke
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DOI：
10.1007/s12035-015-9112-7
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发表时间：
2016-04-01
影响因子：
5.1
通讯作者：
Li, Li-Hong
中科院分区：
文献类型：
--
作者：
Wang, Chao;Gao, Li;Li, Li-Hong
炎症标志物与脑卒中的功能结局和死亡率相关。我们研究了缺血性卒中急性期降钙素原（PCT）和高敏c反应蛋白（Hs-CRP）水平的变化，并评估了这些水平与长期功能结局和死亡率之间的关系。我们前瞻性研究了376例急性缺血性卒中（AIS）患者，这些患者在症状出现后24小时内入院。入院时测量PCT、Hs-CRP和NIH卒中量表（NIHSS）。入院后1年采用改良Rankin量表（mRS）测量长期功能结局。分析PCT、Hs-CRP水平与卒中发病后1年死亡率之间的相关性。功能预后差的患者和非幸存者在入院时PCT和Hs-CRP水平显著升高。多因素logistic回归分析显示，PCT是AIS患者1年功能结局和死亡的独立预后指标[比值比（OR）分别为2.33 （95% CI, 1.33-3.44）和3.11(2.02-4.43)，经年龄、NIHSS、其他预测因素和血管危险因素校正后，两者P < 0.0001]。PCT的受者工作特征曲线下面积为0.77 (95% CI, 0.72-0.83)，死亡率为0.88 （95% CI, 0.84-0.93）。PCT改善了NIHSS功能结局评分的受试者工作特征曲线下面积，从0.74 （95% CI, 0.66-0.81）提高到0.85 (95% CI, 0.76-0.92, P < 0.0001)，死亡率评分从0.77 （95% CI, 0.70-0.83）提高到0.94 （95% CI, 0.89-0.97, P < 0.0001）。入院时血清PCT水平是中国样本缺血性脑卒中后长期功能结局和死亡率的独立预测因子。
Inflammatory markers have been associated with functional outcome and mortality of stroke. We investigated the changes in procalcitonin (PCT) and high-sensitivity C-reactive protein (Hs-CRP) levels during the acute period of ischemic stroke and evaluated the relationship between these levels and the long-term functional outcome and mortality. We prospectively studied 376 patients with acute ischemic stroke (AIS) who were admitted within 24 h after the onset of symptoms. PCT, Hs-CRP, and NIH Stroke Scale (NIHSS) were measured at the time of admission. Long-term functional outcome were measured by modified Rankin scale (mRS) at 1 year after admission. The correlations between the levels of PCT, Hs-CRP, and mortality at 1 year after stroke onset were analyzed. Patients with poor with functional outcome and non-survivors had significantly increased PCT and Hs-CRP levels on admission. Multivariate logistic regression analysis showed that PCT was an independent prognostic marker of 1-year functional outcome and death [odds ratio (OR) 2.33 (95 % CI, 1.33-3.44) and 3.11 (2.02-4.43), respectively, P < 0.0001 for both, adjusted for age, NIHSS, other predictors, and vascular risk factors] in patients with AIS. The area under the receiver operating characteristic curve of PCT was 0.77 (95 % CI, 0.72-0.83) for functional outcome and 0.88 (95 % CI, 0.84-0.93) for mortality. PCT improved the area under the receiver operating characteristic curve of the NIHSS score for functional outcome from 0.74 (95 % CI, 0.66-0.81) to 0.85 (95 % CI, 0.76-0.92; P < 0.0001) and for mortality from 0.77 (95 % CI, 0.70-0.83) to 0.94 (95 % CI, 0.89-0.97; P < 0.0001). Serum level of PCT at admission was an independent predictor of long-term functional outcome and mortality after ischemic stroke in Chinese sample.