So you described a problem, offered no solution. Useless.
A Score of Low-Grade Inflammation for Predicting Stroke Recurrence in Patients with Ischemic Stroke
Authors Wu M, Zhang X, Chen J, Zha M, Yuan K, Huang K, Xie Y, Xue J, Liu X
Received 7 July 2021
Accepted for publication 28 August 2021
Published 14 September 2021 Volume 2021:14 Pages 4605—4614
DOI https://doi.org/10.2147/JIR.S328383
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Professor Ning Quan
Min Wu,1,* Xiaohao Zhang,2,* Jingjing Chen,3,* Mingming Zha,4 Kang Yuan,5 Kangmo Huang,2 Yi Xie,2 Jianzhong Xue,6 Xinfeng Liu1,2,7
1Department
of Neurology, Jinling Hospital, The First School of Clinical Medicine,
Southern Medical University, Nanjing, 210002, People’s Republic of
China; 2Department of Neurology, Jinling Hospital, Affiliated
Medical School of Nanjing University, Nanjing, 210002, People’s
Republic of China; 3Department of Neurology, Changhai Hospital, Navy Medical University, Shanghai, 200433, People’s Republic of China; 4Department of Neurology, Jinling Hospital, Medical School of Southeast University, Nanjing, 210002, People’s Republic of China; 5Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, 210000, People’s Republic of China; 6Department of Neurology, Changshu No.2 People’s Hospital, Changshu, People’s Republic of China; 7Stroke
Center & Department of Neurology, the First Affiliated Hospital of
USTC, Division of Life Sciences and Medicine, University of Science and
Technology of China, Hefei, Anhui, 230001, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Xinfeng Liu
Department
of Neurology, Jinling Hospital, The First School of Clinical Medicine,
Southern Medical University, No. 305 Zhongshan East Road, Xuanwu
District, Nanjing, Jiangsu Province, 210002, People’s Republic of China
Tel +86 138 13835114
Email xfliu2@vip.163.com
Jianzhong Xue
Department
of Neurology, Changshu No.2 People’s Hospital, No. 18 Taishan Road,
Changshu, Jiangsu Province, People’s Republic of China
Tel +86 13506247572
Email xjz2021@sina.com
Background and Purpose:
The impact of low-grade inflammation (LGI) on stroke recurrence has not
been well studied yet. We aimed to evaluate the association between LGI
and stroke recurrence in patients with ischemic stroke.
Methods:
Patients with first-ever ischemic stroke diagnosed within 72 hours of
symptoms onset were consecutively recruited from the Nanjing Stroke
Registry Program. C-reactive protein (CRP) level, white blood cell (WBC)
count, platelet (PLT) count, and neutrophil-to-lymphocyte ratio (NLR)
were conceived as low-grade inflammation biomarkers and combined into a
standardized LGI score. The association of LGI score with the risk of
stroke recurrence was analyzed with multivariate Cox regression models.
Analyses accounting for the competing risk of stroke recurrence and
death were also performed.
Results: Of the 1214
patients studied (median age, 61 years; male, 71.6%), 177 (14.6%)
patients experienced a recurrent stroke with a median follow-up of 23.0
(interquartile ranges, 14.5– 34.0) months. Patients with stroke
recurrence had a higher LGI score (median, 3 versus − 2; P <
0.001) than those without recurrence. The univariate analysis indicated
that patients with LGI scores in the fourth quartile were more likely
to have a stroke recurrence (hazard ratios [HR], 4.312; 95% confidence
interval [CI], 2.675– 6.952; P < 0.001). After adjusting for
potential confounders, the association remained significant in the
multivariate Cox regression model (HR, 4.080; 95% CI, 2.420– 6.879; P < 0.001). Competing risks model and sensitivity analysis further confirmed this conclusion.
Conclusion:
This study showed that an elevated LGI score was associated with a
higher risk of stroke recurrence, independent of other vascular risk
factors.
Keywords: low-grade inflammation, stroke recurrence, ischemic stroke, predictor
Introduction
In most countries, the incidence of ischemic stroke is increasing with the age of the general population.1,2 A recurrent stroke occurs more frequently during the first years after stroke, with estimated frequency ranging between 7.1% and 26.0%, depending on the population studied and the length of follow-up.3–5 Furthermore, stroke recurrence is more fatal and disabling than the first-ever stroke.6 Thus, early identification and management of the high risk of recurrent stroke patients are of great significance.
Low-grade inflammation (LGI) has been reported to be associated with several chronic conditions including cardiovascular disease, cancer, and neurodegenerative disease.7–9 Due to the sensitivity to lifestyle modifications, LGI also emerged as an important target for disease prevention.10 Several biomarkers, both circulating (ie, C-reactive protein [CRP]) and cellular (ie, platelet [PLT] and white blood cell [WBC] count) have been recognized as indicators of LGI.11,12 The CAPRIE study (Clopidogrel versus Aspirin in Patients at Risk of Ischemic Events) demonstrated that increased leukocyte count was related to recurrent ischemic stroke.13 However, several large-scale epidemiological studies on CRP level and recurrent vascular events yielded inconsistent results, some showing significant positive associations between CRP and stroke recurrence,14 whereas others indicated no association.15 Recently, the neutrophil-to-lymphocyte ratio (NLR) was also shown to be a reliable marker of cellular inflammation.16 Considering that these LGI markers do not occur separately in a patient, a comprehensive approach that takes into account the possible synergistic effects might better illustrate the LGI status. Meanwhile, the association of LGI status with recurrent stroke has not been fully investigated.
Thus, the study aimed to use a predefined composite LGI score based on the 4 abovementioned individual LGI markers and to investigate its relationship with stroke recurrence in a cohort of patients who initially presented with first-ever ischemic stroke.
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