So you should be be working on solutions to increase this ratio. Like some actual useful research?
Elevated Albumin to Globulin Ratio on Day 7 is Associated with Improved Function Outcomes in Acute Ischemic Stroke Patients with Intravenous Thrombolysis>
Authors Yang D, Shen J, Huang H, Wang J, Sun F, Zeng T, Qiu H, Xie H, Chen Y, Li S, Chen Y, Chen G , Weng Y
Received 30 October 2021
Accepted for publication 29 March 2022
Published 26 April 2022 Volume 2022:15 Pages 2695—2705
DOI https://doi.org/10.2147/JIR.S347026
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Professor Ning Quan
Dehao Yang,1,* Jiamin Shen,2,3,* Honghao Huang,2,3,* Jianing Wang,2,3 Fangyue Sun,2,3 Tian Zeng,2,3 Haojie Qiu,2,4 Haobo Xie,2,3 Yilin Chen,2,3 Shengqi Li,2,3 Yiqun Chen,2,3 Guangyong Chen,2 Yiyun Weng5
1Department
of Neurology, The Second Affiliated Hospital, Zhejiang University
School of Medicine, Hangzhou, People’s Republic of China; 2Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, People’s Republic of China; 3School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, People’s Republic of China; 4School of the Second Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, People’s Republic of China; 5Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People’s Republic of China
*These authors contributed equally to this work
Correspondence:
Dehao Yang, Department of Neurology, The Second Affiliated Hospital,
Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang,
People’s Republic of China, Email wzmcydh@163.com; Yiyun Weng,
Department of Neurology, The First Affiliated Hospital of Wenzhou
Medical University, Wenzhou, 325000, Zhejiang, People’s Republic of
China, Email wengyiyun2012@126.com
Background and Purpose:
Albumin to globulin ratio (A/G) has been established as a
representative biomarker for assessing inflammation and nutritional
status. However, the prognostic value of A/G has rarely been reported in
acute ischemic stroke (AIS) patients with intravenous thrombolysis
(IVT).
Methods: A total of 311 AIS patients who had
undergone IVT and completed 3-month follow-up were retrospectively
recruited in this study. Albumin (Alb), globulin (Glb) and A/G on
admission, within 24 hours after IVT and on day 7 were recorded. Poor
outcome was defined as death or major disability (modified Rankin Scale,
3– 6) at 3 months.
Results: Among the 311 cases,
260 patients had admission blood samples, 296 cases had blood samples
within 24 hours after IVT and 126 cases had blood samples on day 7. The
patients with and without available blood samples were well-balanced.
During the first 24 h, we observed A/G to increase significantly
compared with baseline whereas at day 7 it was almost back to baseline
in patients with a poor outcome. Receiver operating characteristic (ROC)
curves analysis showed that A/G had a better performance in
discriminating patients at high risk and low risk of a poor outcome than
either Alb or Glb alone and carried the highest predictive ability on
day 7 (AUC = 0.807). Lower 7-day A/G was independently associated with a
poor outcome (per-SD increase, OR = 0.182, 95% CI: 0.074– 0.446).
Conclusion: A/G is an important prognostic indicator for AIS outcomes and merits dynamic monitoring.
Keywords: ischemic stroke, albumin-globulin ratio, intravenous thrombolysis
Introduction
Acute ischemic stroke (AIS), a type of acute cerebrovascular disease, caused by obstruction of blood vessels, is a primary disease contributing to adult morbidity and mortality. Intravenous thrombolysis (IVT) using recombinant tissue plasminogen activator (rt-PA) within 4.5 hours after AIS onset is accepted as a standard therapy for AIS patients nowadays. However, nearly two-thirds of AIS patients do not experience clinical benefit after IVT. This situation creates a need for prognostic factors that would help clinicians identify those AIS patients who are more likely to have poor function outcomes.
Blood biochemistry tests are one of the most commonly prescribed tests. Blood samples could be obtained from AIS patients at an early stage. Total serum protein is composed of albumin (Alb) and globulins (Glb), and abnormalities in the albumin/globulin ratio (A/G) have been observed in different clinical states including malnutrition, cancer, severe liver disease and rheumatic diseases.1–3 A recent study reported that higher serum A/G is associated with better cognitive function in community-dwelling older people.4 Besides, A/G showed a good prognostic value and remained an independent predictor of 90-day and 1-year mortality in patients with chronic heart failure.5 Beamer et al.6 suggested that lower levels of A/G are associated with increased risk for recurrent vascular events after AIS. However, few studies have examined the prognostic value of A/G in AIS patients with r-tPA administration. In the present study, considering Alb, Glb and A/G might be dynamic variables during hospitalization, we aimed to investigate (1) the dynamic profile of Alb, Glb and A/G in AIS patients during the first 7 days; (2) the association between Alb, Glb, A/G and 3-month clinical outcome; and (3) the predictive ability and incremental predictive ability of Alb, Glb and A/G for poor function outcomes in AIS patients treated with IVT r-tPA.
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