目标:纤维蛋白原,在初级止血中是必不可少的,血小板聚集,和白细胞-内皮细胞相互作用,也与急性缺血性卒中(AIS)的风险增加有关。然而,其对AIS患者结局的影响尚不清楚.这项研究检查了纤维蛋白原水平与AIS后三个月不良结局风险之间的相关性。
方法:这是一项在韩国进行的前瞻性队列研究的二次分析。样本包括2010年1月至2016年12月在韩国医院接受治疗的1851名AIS患者。建立统计模型以了解纤维蛋白原水平(mg/dL)与不良结局(mRs≥3)之间的关系。包括逻辑回归模型,广义加性模型(GAM),和平滑曲线拟合(惩罚样条)。对数似然比检验已用于评估最佳拟合。为了确保结果的鲁棒性,在排除TG>200mg/dl和BMI>25kg/m2的参与者后,通过重新分析两者的关系进行敏感性分析.还进行了亚组分析,以评估影响因素是否改变了纤维蛋白原水平与不良结局之间的关联。
结果:在调整包括年龄在内的多个协变量后,BMI,性别,LDL-c,TG,HGB,HDL-c,BUN,FPG,ALB,PLT,AF,高血压,吸烟,DM,mRs在入学时得分,二元logistic回归模型显示,纤维蛋白原水平与AIS患者不良结局风险之间存在显著正相关(OR=1.215,95%CI:1.032~1.429,p=0.019).敏感性分析支持这些发现,在TG<200mg/dL(OR=1.221,95%CI:1.036-1.440)和BMI<25kg/m2(OR=1.259,95%CI:1.051-1.509)的患者亚群中观察到相似的OR。此外,纤维蛋白原水平和结局之间的关系是非线性的,临界阈值为2.74g/L。在拐点以下,不利结果的OR为0.666((95%CI:0.360,1.233,p=0.196),而在它之上,OR增加至1.374(95%CI:1.138,1.659)。
结论:本研究提供了AIS患者纤维蛋白原水平与3个月不良功能结局之间呈正相关和非线性相关的证据。当纤维蛋白原水平超过2.74g/L时,观察到不良结局的风险与显著正相关.本研究为优化急性缺血性脑卒中患者的康复锻炼和促进临床咨询提供了进一步的参考。
OBJECTIVE: Fibrinogen, essential in primary hemostasis, platelet aggregation, and leukocyte-endothelial interactions, is also associated with a heightened risk of acute ischemic stroke (AIS). However, its influence on AIS patient outcomes is unclear. This study examines the correlation between fibrinogen levels and the risk of unfavorable outcomes three months post-AIS.
METHODS: This is a secondary analysis of a prospective cohort study conducted in Korea. The sample consisted of 1851 AIS patients who received treatment at a Korean hospital between January 2010 and December 2016. Statistical models were established to understand the relationship between fibrinogen levels(mg/dL) and unfavorable outcomes(mRs ≥ 3), including logistic regression models, Generalized Additive Models (GAM), and smooth curve fitting (penalized splines). The log-likelihood ratio test has been utilized to evaluate the best fit. To ensure the robustness of the results, sensitivity analyses were conducted by reanalyzing the relationship after excluding participants with TG > 200 mg/dl and BMI > 25 kg/m2. Subgroup analyses were also performed to assess whether influencing factors modify the association between fibrinogen levels and unfavorable outcomes.
RESULTS: After adjusting for multiple covariates including age, BMI, sex, LDL-c, TG, HGB, HDL-c, BUN, FPG, ALB, PLT, AF, hypertension, smoking, DM, mRs score at admission, the binary logistic regression model demonstrated revealed a significant positive association between fibrinogen levels and the risk of unfavorable outcomes in AIS patients (OR = 1.215, 95% CI: 1.032-1.429, p = 0.019). Sensitivity analyses supported these findings, with similar ORs observed in subsets of patients with TG < 200 mg/dL (OR = 1.221, 95% CI: 1.036-1.440) and BMI < 25 kg/m2 (OR = 1.259, 95% CI: 1.051-1.509). Additionally, the relationship between fibrinogen levels and outcomes was nonlinear, with a critical threshold of 2.74 g/L. Below the inflection point, the OR for unfavorable outcomes was 0.666 ((95% CI: 0.360, 1.233, p = 0.196), whereas above it, the OR increased to 1.374 (95% CI: 1.138, 1.659).
CONCLUSIONS: This study has provided evidence of a positive and nonlinear correlation between fibrinogen levels and 3-month poor functional outcomes in patients with AIS. When fibrinogen levels exceeded 2.74 g/L, a significant and positive association was observed with the risk of poor outcomes. This study provides a further reference for optimizing rehabilitation exercises and facilitating clinical counseling in patients with acute ischemic stroke.