血糖与4种炎性标志物升高对高龄急性缺血性卒中患者住院死亡风险的影响

Effect of hyperglycemia and four elevated inflammatory biomarkers on the risk of in-hospital mortality in acute ischemic stroke patients

目的:探索高龄急性缺血性卒中患者高血糖、炎性标志物及二者并存与患者住院死亡风险的关系。方法:基于电子病历记录系统(electrical medical record,EMR)回顾性连续采集急性缺血性卒中患者人口学信息、入院空腹血糖、炎性标志物等数据,根据临床结局进行分组,比较组间人口学特征和临床指标,筛选潜在影响临床结局的变量;并以影响临床结局的变量为分组变量,以临床结局为结局变量,绘制ROC曲线并计算和比较各变量曲线下面积(area under the curve,AUC);以住院时间为时间变量,对研究对象进行生存分析。结果:共926例患者纳入本研究,其中住院期间死亡人数为377例;校正人口学特征、既往病史和血液检测指标后,高血压病史、冠心病史和CRP水平升高是患者住院死亡的相关因素(P<0.05),而血糖和其他炎性标志物差异无统计学意义(P>0.05);ROC结果提示CRP曲线下面积大于其他变量(P=0.04),阳性预测值(positive predictivevalue,PPV)为60.16%,阴性预测值(negative predictive value,NPV)为73.06%;生存分析结果提示CRP升高组和高血糖和白细胞升高患者死亡风险较对照组差异无统计学意义(P>0.05)。结论:炎性标志物水平升高是高龄急性缺血性卒中患者住院死亡的危险因素。

Objective: To investigate the association of in-hospital mortality with coexistence of hyperglycemia and elevated biomarkers of inflammation among elderly acute ischemic stroke patients. Methods: Based on the electrical medical record (EMR), we performed a retrospective study which consecutively collected data of the patients with acute ischemic stroke. After patients were grouped according clinical outcomes, demographic characteristics and clinical features were compared between groups in order to screen potential variables affecting clinical outcomes. Then, included variables were considered to be the indicators for grouping patients, with clinical outcomes as outcome variables, we performed ROC and its AUC respectively. With hospitalization time serving as time variable, survive analysis method was used to analyzed mortality risk between groups. Results: Nine hundred and twenty-six patients were enrolled in the final analysis, 377 patients of which were recorded dead during hospitalization (the dead group). After the adjustment of demographic characteristics, history of hypertension and prior stroke and elevated C-reactive protein (CRP)at admission were regarded as potential factors for the deaths of patients (P<0.05). Whereas, serum glucose level and other three inflammatory biomarkers were similar between groups. The test of ROC among risk factors indicated that the AUC of CRP was larger than others (P=0.04). The survival analysis failed demonstrate that the mortality in groups divided by CRP and hyperglycemia complicated with leukocytosis were higher than that in the control group. Conclusion: Elevated biomarkers of inflammation are risk factors for in-hospital mortality elderly patients with acute ischemic stroke.