| Objective Acute ischemic stroke(AIS)is the main cause of abnormal death and disability in the elderly,and its prognosis is generally poor,with high mortality and recurrence rates.At present,the pathogenesis of AIS is still unclear,and there is a lack of effective biological early-warning molecules and treatment methods in clinical practice.This is a key technical barrier that is difficult to implement for clinical treatment of AIS and improving poor prognosis.Based on this,this study aims to screen biomarkers related to the occurrence of AIS through a clinical retrospective case-control study,and to analyze the medication use of inpatients with AIS in our hospital.It is beneficial to reduce the mortality and disability rate of AIS patients and improve the quality of life of AIS patients,and it has important guiding significance for exploring new AIS diagnosis and treatment programs.Methods A total of123 patients with AIS admitted from the Department of Neurology of the Affiliated Hospital of Inner Mongolia Medical University from May 2019 to September 2019 were selected to construct a clinical study cohort.The baseline data and laboratory examination results of the study cohort were collected.The recurrence of AIS was the primary endpoint to follow up the study cohort and the modified Rankin scale(m RS)was used to evaluate the prognosis of the patients.Record the time when AIS reoccurred.Through receiver operator characteristic(ROC)curve,COX regression analysis and Kaplan-Meier analysis,the relationship between peripheral blood biochemical indicators and the risk of AIS recurrence was studied.Use the hospital PASS system to extract elderly AIS patients who meet the screening criteria as the research object,view the disease history records of the research object,and collect the patient’s age,gender,ethnicity,doctor’s order and medication status to build an AIS patient database.Statistics and sorting out the characteristics of the types and quantities of drugs used by the research subjects and the types of medical insurance.According to the 2019 Beers criteria,the second version of the STOPP/START criteria,and the criteria of potentially inappropriate medications for older adults in China(2017 version),evaluate the patient’s medication use,and explore possible factors that affect the occurrence of Potentially Inappropriate Prescription(PIP).Results In order to screen the biomarkers related to the occurrence of AIS,we followed up the clinical study cohort,took the recurrence of AIS as the primary endpoint,and recorded the time of its occurrence.With an average follow-up of13.47 months(standard deviation: 1.97 months;median: 13.35 months),35 subjects had recurrence of AIS.The level of Cys C in peripheral blood of patients with recurrence of AIS was significantly higher than that of patients without recurrence(0.92±0.43mg/L vs0.75±0.34 mg/L,p=0.02).ROC curve analysis showed that the area under curve of Cys C was0.628(95% CI: 0.513-0.743,p=0.035).Cox regression analysis illustrated that the serum Cys C level was associated with risk of recurrent AIS(HR=1.946,95% CI: 1.038-4.649,p=0.038)after smoking and drinking were adjusted.123 AIS patients were divided into three groups according to tertile level of serum Cys C levels,Kaplan-Meier analysis showed that the cumulative risk of recurrent AIS was significantly increased as increasing in serum Cys C level(Log Rank=4.269,p=0.038).In order to analyze the drug use of AIS patients in our hospital,we additionally included 114 elderly AIS patients as the research objects.The average age of the patients was 71.37 years(standard deviation: 4.68 years),including 81 male patients(71.05%)and 8 ethnic minority patients(7.02%).The average hospital stay of patients was 12.54±2.45 days,the average hospitalization amount was 14246.23±6397.06 yuan,the average number of diagnosed diseases was 7.31±2.89,and the average number of medications was 11.96±4.62.91 patients(79.82%)had at least one underlying disease.114 patients used a total of 204 drugs during hospitalization,of which atorvastatin calcium tablets were used the most frequently.According to the 2019 Beers criteria,35 patients(30.70%)had potentially inappropriate medications(PIMs),and the most common PIMs was diuretics(17cases,31.48%).According to the second version of the STOPP criteria,72 patients(63.16%)had at least one PIM,and the most common types of PIM were antiplatelet and anticoagulant drugs(83 cases,77.57%).According to the criteria of potentially inappropriate medications for older adults in China(2017 version),65 patients(57.02%)had PIMs,which was mainly focused on the use of clopidogrel(50 cases,49.02%).Based on the START criteria,29patients(25.44%)had prescription omissions(PPOs).The consistency test results show that the STOPP criteria has the highest consistency with the Chinese criteria,the STOPP criteria has a higher sensitivity,and the Beers criteria has a higher specificity.Logistics regression analysis shows that the number of drugs used is a risk factor affecting the occurrence of PIM,and the number of diagnosed diseases is significantly positively correlated with the occurrence of PPO.Conclusion: The level of Cys C in peripheral blood has a certain clinical value in predicting the recurrence risk of AIS.PIP in elderly patients with AIS is very common in clinical work.The key work of clinical pharmacists in the future is to select the appropriate PIP evaluation criteria and improve the rational drug use level of AIS patients according to the actual situation of our hospital. |
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