Correlation Between Plasma Fibrinogen Levels And Post-stroke Cognitive Impairment In Patients With Acute Ischemic Stroke

Objectives:To explore the correlation between plasma fibrinogen(FBG)levels and post-stroke cognitive impairment(PSCI)in patients with mild acute ischemic stroke(AIS),expecting to provide new clinical diagnostic ideas for early identification of PSCI.Methods:Three hundred and ninety-eight patients with mild AIS treated at the Department of Neurology,Baiqiu’en First Hospital of Jilin University between March 2019 and June 2022 were selected.General information,laboratory tests,neuropsychological test scores and imaging data were collected from the patients.The grouping criteria used the Montreal cognitive assessment scale(Mo CA),and after correcting for educational level,Mo CA < 22 was the PSCI group and Mo CA ≥ 22 was the post-stroke non-cognitive impairment(PSNCI)group.Firstly,the differences in general demographic data,routine laboratory tests and FBG between the PSCI and PSNCI groups were compared.Secondly,the correlation between FBG level and overall cognitive function and cognitive function in each cognitive domain was analyzed.In addition,the differences in the incidence of PSCI and cognitive function between different FBG levels were analyzed.Then,all patients were grouped according to age(65 years as the cut-off)and gender,and the results of the effect of FBG on the occurrence of PSCI in AIS patients of different ages and genders were analyzed separately.In the next step,logistic regression analysis was performed to explore the independent correlates of PSCI.Finally,the predictive value of FBG and combined with other factors on PSCI was assessed using the receiver operating characteristic curve(ROC).Results:1.The differences in age,gender,education,previous stroke history,systolic blood pressure,and NIHSS score between patients in the PSCI and PSNCI groups were statistically significant(P< 0.05).2.The FBG level in the PSCI group was significantly higher than that in the PSNCI group,and the difference was statistically significant(P < 0.05).3.FBG,as a continuous variable,was negatively correlated with overall cognitive function(MMSE,Mo CA)and partial cognitive domain cognitive function(naming ability,attention,executive power,and computational power)scores(r=-0.157,r=-0.177,r=-0.117,r=-0.130,r=-0.137,and r=-0.124,respectively,all P<0.05).4.The incidence of PSCI differed between groups with different FBG levels,and the incidence of PSCI showed an overall increasing trend as the FBG level increased(P < 0.05).5.Compared to the low level FBG group,the higher level FBG group had lower cognitive function scores in overall cognitive function(MMSE,Mo CA)and each cognitive domain(naming ability,attention,executive power,computational power,delayed recall ability,and orientation)(P< 0.05).6.Grouped by age and gender,higher levels of FBG were found to be associated with a higher incidence of PSCI in younger patients(under 65 years)and in male patients(P < 0.05).In contrast,there was no such correlation in older(≥65 years)and female patients.7.Age,education,NIHSS score,previous stroke history,neutrophil-to-lymphocyte ratio(NLR),and FBG level were independently associated with the development of PSCI(P < 0.05).After adjusting for other confounding factors,FBG levels remained independently associated with the occurrence of PSCI(P < 0.05).8.ROC analysis of single-factor FBG on the occurrence of PSCI showed an AUC=0.594(P=0.001);when FBG was combined with age,education,previous stroke history,NIHSS score,NLR and uric acid to construct a new predictive model,the AUC=0.786(P<0.001).Conclusions:1.FBG levels were higher in the PSCI group than in the PSNCI group,and cognitive function was severely impaired in PSCI patients as FBG levels increased.2.FBG levels can reflect the incidence of PSCI,with a corresponding increase in the incidence of PSCI with higher FBG levels,and this correlation is particularly significant in younger patients(under 65 years of age)and in male patients.3.High FBG levels were an independent risk factor for the development of PSCI.FBG significantly improved the predictive efficacy of PSCI when combined with age,education,stroke history,NIHSS score,uric acid and NLR.