A Nomogram That Includes Neutrophils and High-Density Lipoprotein Cholesterol Can Predict the Prognosis of Acute Ischaemic Stroke

 Useless. Recovery predictions do ABSOLUTELY NOTHING  for getting survivors recovered.

nomogram

a diagram representing the relations between three or more variable quantities by means of a number of scales, so arranged that the value of one variable can be found by a simple geometric construction, for example, by drawing a straight line intersecting the other scales at the appropriate values.

A Nomogram That Includes Neutrophils and High-Density Lipoprotein Cholesterol Can Predict the Prognosis of Acute Ischaemic Stroke

Nan Wang^1,2, Hongbing Liu¹, Mengke Tian¹, Jing Liang¹, Wenxian Sun¹, Luyang Zhang¹, Lulu Pei¹, Kai Liu¹, Shilei Sun¹, Jun Wu¹, Yuan Gao¹, Yuming Xu¹, Yilong Wang^2* and Bo Song^1*

• ¹Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
• ²Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

Lipids are implicated in inflammatory responses affecting acute ischaemic stroke prognosis. Therefore, we aimed to develop a predictive model that considers neutrophils and high-density lipoprotein cholesterol to predict its prognosis. This prospective study enrolled patients with acute ischaemic stroke within 24 h of onset between January 2015 and December 2017. The main outcome was a modified Rankin Scale score ≥3 at the 90th day of follow-up. Patients were divided into training and testing sets. The training set was divided into four states according to the median of neutrophils and high-density lipoprotein cholesterol levels in all patients. Through binary logistic regression analysis, the relationship between factors and prognosis was determined. A nomogram based on the results was developed; its predictive value was evaluated through internal and external validations. Altogether, 1,090 patients were enrolled with 872 (80%) and 218 (20%) in the training and testing sets, respectively. In the training set, the major outcomes occurred in 24 (10.4%), 24 (11.6%), 37 (17.2%), and 49 (22.3%) in states 1–4, respectively (P = 0.002). Validation of calibration and decision curve analyses showed that the nomogram showed better performance. The internal and external testing set receiver operating characteristics verified the predictive value [area under the curve = 0.794 (0.753–0.834), P < 0.001, and area under the curve = 0.973 (0.954–0.992), P < 0.001, respectively]. A nomogram that includes neutrophils and high-density lipoprotein cholesterol can predict the prognosis of acute ischaemic stroke, thus providing us with an effective visualization tool.

Introduction

Stroke is the leading cause of disability and the second leading cause of death worldwide (1). However, stroke is the leading cause of both death and disability in China (2). Ischaemic events are the first to occur in all stroke events, with a rate of ~70% (3). Statistics show that in 2018, 1.57 million stroke deaths were reported in China. Stroke has a significant impact on its socio-economic and family burdens. Therefore, tools that accurately predict its prognosis are needed, especially ischaemic stroke.

Many factors can affect the prognosis of ischaemic stroke, including the immune-inflammatory response, which is an essential process after stroke (4). Neutrophils are the first cells to reach the lesions after stroke and participate in a series of complex inflammatory responses (5). They are involved in the destruction and repair of local brain tissue in cerebral infarction. Studies have shown that inflammatory cells in peripheral blood after stroke also change along with local inflammatory cells (6), thus, testing patients' peripheral blood provides a clinical basis for quick judgment of their prognosis. For example, Zhu et al. (7) have shown that peripheral neutrophil count after stroke is associated with the stroke prognosis.

In addition, lipids are important factors in the inflammatory response. Recent studies have shown that high-density lipoprotein cholesterol (HDL-C) inhibits neutrophil deformation and platelet aggregation (8, 9), and inhibits the formation of neutrophil traps (10). These can prevent further damage to the infarcted tissue after promoting thrombosis. Therefore, we aimed to develop a predictive model that includes neutrophils and high-density lipoprotein cholesterol to predict the prognosis of acute ischaemic stroke (AIS).

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