Significance Of DBLR,MRVLR And DBIL In Predicting Severity And Prognosis Of Acute Ischemic Stroke

ObjectiveThis study was to evaluate whether direct bilirubin（DBIL）,mean platelet volume lymphocyte ratio（MRVLR）,direct bilirubin lymphocyte ratio（DBLR）can be used as an index to predict the severity and short-term prognosis of acute ischemic stroke by observing the correlation between direct bilirubin（DBIL）,mean platelet volume lymphocyte ratio（MRVLR）,direct bilirubin lymphocyte ratio（DBLR）and stroke severity.Methods234 Patients with acute ischemic stroke who were treated in the first Hospital of Lanzhou University within 24 hours of onset were retrospectively included in the data from January 2019 to March 2021,and the data from April 2021 to November 2021were collected prospectively.In addition,180 healthy person who underwent physical examination in the first Hospital of Lanzhou University in the same period were randomly selected as the control group.The general data of the patients,the time from onset to admission,NIHSS at admission and relevant laboratory indexes at admission were collected,and DBLR and MRVLR were calculated.According to the NIHSS score on admission,the case group was divided into mild stroke（NIHSS score≤6）,moderate and severe stroke（15>NIHSS score>6）and severe stroke（NIHSS score≥15）.According to whether the MRS score of 7±2 days was higher than 3,the patients were divided into two groups:good prognosis group and poor prognosis group.（1）The differences of past history,general clinical data and laboratory test related indexes between AIS group and healthy control group were compared.（2）The differences among different NIHSS score subgroups were analyzed:the differences of general medical history,TOAST classification and past history among the three groups were analyzed by row*contingency table chi-square test,and the differences of time from onset to admission,DBLR,MRVLR and other laboratory indexes among the three groups were analyzed by Kruskal-Wallis test.Rank correlation analysis was used to analyze the correlation between stroke severity and statistically significant laboratory indicators,and multivariate ordered Logistic regression was used to analyze the independent risk factors of AIS severity.The predictive value of DBIL,DBLR and MPVLR on admission to severe AIS was evaluated by receiver operating curve（ROC）.（3）According to the 7±2-day MRS score,the differences between the two groups in gender,TOAST classification and past history were analyzed by X~2test,and the differences in the time from onset to admission,NIHSS score and laboratory results between the two groups were analyzed by Mann-Whitney U test.Rank correlation analysis was used to analyze the correlation between poor prognosis of stroke and statistically significant test indexes.ROC curve was used to evaluate the predictive value of DBIL,DLR and MPVLR on admission for poor short-term prognosis.（4）According to the TOAST classification,the AIS group was divided into three groups:LAA type（large atherosclerotic type）,CE type（cardiogenic type）and SAO type（small artery occlusive type）,so the difference in quantity was excluded.Kruskal-Wallis test was used to compare the differences of DBLR,MRVLR and other laboratory indexes among LAA group,CE group and SAO group.The predictive value of DBIL,DBLR and MPVLR on LAA stroke evaluated by ROC curve.Results（1）Compared with the healthy control group,the AIS group had higher W BC count（Z=-3.581,P=0.000）、NEU count（Z=-3.907,P=0.000）、HGB（Z=-2.384,P=0.007）、MRV（Z=-8,859,P=0.000）、TBIL（Z=-3.685,P=0.000）、DBIL（Z=-7.213,P=0.000）、HCY（Z=-6.835,P=0.000）,Have a low LYM count（Z=-907,P=0.000）、E O count（Z=-8.355,P=0.000）、MCV（Z=-5.905,P=0.000）、PLT（Z=-2.182,P=0.029）、UA（Z=-2.931,P=0.003）、TC（Z=-5.214,P=0.000）、HDL-C（Z=-5.315,P=0.000）、LD L-C（Z=-4.706,P=0.000）,The differences were statistically significant（P<0.05）.Compared with the control group,the level of RBC in the AIS group was hig her and the TG level was lower than that in the control group,and the differe nce was not statistically significant.（2）The incidence rate of atrial fibrillation in moderate and severe AIS group was significantly higher than that in mild AIS group（X~2=13.091.P=0.001）.The TOAST type in mild AIS group was mainly SAO type（45.9%）.The TOAST type in moderate and severe AIS group was mainly CE type（50%）,and the main TOAST type in severe AIS group was LAA type（45.9%）.There were significant differences among the three groups.The moderate,severe and severe AIS group had higher WBC count,NEUT count,TBIL level,DBIL level,IBIL level,DBLR（median（1.99 vs.3.61 vs.3.75）,Z=29.989,P<0.001）,MRVLR（median（8.26 vs.16.15 vs.14）,Z=18.239,P<0.001）,and there were significant differences among the three groups.Compared with mild AIS stroke,moderate and severe stroke had lower LYM count and EO count,and there were significant differences among the three groups（P<0.05）.Spearman correlation analysis showed that WBC count,NEUT count,DBIL,DBLR,and MRVLR were positively correlated with the degree of neurological impairment,EO count and LYM count were negatively correlated with the degree of neurological impairment.By sequential Logistic regression analysis,it was found that.TOAST classification,WBC count,DBIL,DBLR and MRVLR were risk factors for the degree of neurological impairment in patients with ACI.ROC curve was used to predict the predictive value of DBIL,DBLR and MPVLR for severe AIS at admission.The results show that the area under the curve（AUC）of DBLR is 0.612,the best diagnostic value is 2.82,the sensitivity is 47.2%,and the specificity is 79.4%（AUC of MRVLR is 0.668,the best diagnostic value is 13.57）,the sensitivity is 70.5%,and the specificity is 52.7%（P=0.005,95%CI:0.537-0.686）.The AUC of DBIL was 0.596,the best diagnostic value was 2.85,the sensitivity was 72.7%,and the specificity was43.5%P=0.017,95%CI:0.507-0.663).（3）According to the MRS score of 7±2 days,the patients with AIS were divided into two groups:good prognosis group（MRS score:0-2）and poor prognosis group（MRS score:3-6）.The TOAST type in the good prognosis group was mainly SAO type（37%）,and the TOAST type in the poor prognosis group was mainly LAA type（72.6%）（X ~2=37.659,P<0.001）.The median NIHSS score on admission of the two groups was 6 vs.15,and there was significant difference between the two groups（P<0.001）.Mann-Whitney U rank sum test analysis showed that compared with the good prognosis group,the poor prognosis group had higher WBC count,NEUT count,DBIL,DBLR and MRVLR levels,lower LYM count and EO count,and there were significant differences between the two groups（P<0.05）.Spearman correlation analysis showed that NIHSS score,WBC count,LYM count,NEUT count,DBIL,DBLR,PLR and MRVLR were positively correlated with 7±2 day MRS score,while EO count and LYM count were negatively correlated with 7±2 day MRS score.The DBLR and MRVLR of good prognosis group and poor prognosis group were analyzed by ROC curve.The results showed that the AUC of DBLR was 0.650,the best diagnostic value was 2.86,the sensitivity was 69.8%,and the specificity was58.5%（AUC of MRVLR was 0.635,the best diagnostic value was 10.35）,and the sensitivity and specificity were 55.7%and 70.1%（P=0.000,95%CI:0.565-0.663）.The AUC of DBIL was 0.582,the best diagnostic value was 2.55,the sensitivity was80.8%,and the specificity was 36.6%（P=0.031,95%CI:0.509-0.654）.Binary Logistic analysis showed that DBIL>2.86 was an independent risk factor for poor prognosis.（4）Differences of laboratory test indexes among LAA,CE and SAO subg roups:Kruskal-Wallis rank sum test analysis showed that compared with SAO stroke group,LAA and CE stroke group had higher NEUT count,TBIL,DBIL,IBIL,HDL-C,DBLR and MRVLR levels.There were lower LYM count,EO c ount,TC and LDL-C level,and higher TG and TBIL in CE type,and there w ere significant differences among the three groups.Compared with SAO type A IS group,LAA type and CE type stroke had higher MONO,RBC,HGB,MPV,UA,but there was no statistical significance.The ROC curve of LAA type A IS was analyzed.The results showed that the AUC of DBLR was 0.612,the b est diagnostic value was 1.93,the sensitivity was 82.3%,the specificity was38.6%,the AUC of Magi was 0.601,the best diagnostic value was 12.1,the sens itivity was 42.1%,the specificity was 77.2%,the AUC of DBIL was 0.603,th e best diagnostic value was 4.05umol/L,the sensitivity was 42%,and the speci ficity was 76.9%.The difference has statistical meaning（P<0.05）.ConclusionThe levels of DBIL,DBLR and MRVLR on admission were positively correlated with the degree of neurological impairment and poor prognosis of patients with VI.The higher their values,the more serious the condition and the worse the prognosis of AIS patients.Secondly,TOAST classification,DBIL,DBLR and MRVLR were risk factors for the degree of neurological impairment inpatients with AIS,and DBLR>2.86 was an independent risk factor for poor prognosis.TOAST classification as an indirect response to the severity of acute ischemic stroke,it is found that the level of total lycopene may be a biological indicator of cardiogenic stroke.In addition,the levels of DBIL,DBLR and MRVLR on admission had certain predictive value for LAA stroke,and the predictive ability of DBLR was better than that of MRVLR and DBIL.