Investigated The Prognostic Value Of Plasma Osteopontin And The NLR In Patients With Acute Cerebral Infarcts Treated With Intravenous Thrombolysis

Objective: To study the relationship between plasma osteopontin(OPN)levels and the neutrophil to lymphocyte ratio(NLR)and clinical outcome before and 24 hours after thrombolysis in patients with acute brain infarction(ACI)treated with a recombinant tissue type fibrinogen activator(rt-PA),and to study the value of plasma levels of OPN and NLR and their combination in the prognosis of thrombolytic therapy in patients with ACI.Methods: One hundred patients with onset of ACI within 4.5 h were included in this prospective study,all of whom were treated with rt-PA.To evaluate the prognosis of early neurological function after thrombolysis,all100 study subjects were divided into a good neurological improvement group(ENI)and a poor neurological improvement group(NENI)based on the difference between the NIHSS score at 24 h after thrombolysis and the NIHSS score before thrombolysis(ΔNIHSS):73 in the ENI group(ΔNIHSS≥ 4 points or complete neurological recovery)and 27 in the NENI group(ΔNIHSS <4 points).To judge the prognosis after 3 months,the modified Rankin Scale(m RS)was used for scoring and divided into two groups: 78 in the GPG group(m RS score ≤ 2)and 22 in the PPG group(m RS score >2).Independent sample t-test was used to compare the high and low plasma OPN and NLR before and 24 hours after thrombolysis in the ENI and NENI,GPG and PPG groups to judge whether there was any difference.Then logistic regression was used to analyze whether there was any relationship between plasma OPN and NLR levels and early neurological functional outcome and poor prognosis at 3 months.Plasma OPN and NLR and the combination of both were plotted against the 3-month the receiver characteristic curve(ROC)of plasma OPN,NLR and the combination of both were plotted against the 3-month prognosis,and the optimal cut-off point was determined.Finally,the Delong test was used to compare the area under the curve of plasma OPN and NLR levels and the combination of both,and to evaluate the diagnostic value of OPN,NLR and the combination of OPN and NLR in the prognosis of patients with ACI thrombolysis.Results: 1.The plasma OPN and NLR levels before thrombolysis were not significantly different between the ENI and NENI groups(P≥0.05);the plasma OPN levels before thrombolysis were significantly different between the GPG and PPG groups(P<0.05),but the NLR levels before thrombolysis were not significantly different between the two groups(P≥0.05).2.Plasma OPN and NLR levels were significantly different at 24 hours after thrombolysis between the ENI group and the GPG group(P <0.05).3.The ENI and NENI groups and the GPG and PPG groups Logistic correlation analysis concluded that: high levels of plasma OPN(OR=1.570P=0.024)and high levels of NLR(OR=1.221 P=0.035)at 24 hours after thrombolysis were associated with poor early neurological improvement;poor early neurological improvement(OR=0.003 P=0.000),high levels of plasma OPN at 24 hours after thrombolysis(OR=7.417 P=0.007)and high levels of NLR(OR=2.2263 P=0.006)were associated with poor prognosis at 3 months.4.The diagnostic performance of ROC was evaluated and it was concluded that high levels of plasma OPN,NLR and the combination of both at 24 hours after thrombolysis were good predictors of poor 3-month prognosis in patients with ACI.5.In terms of discriminative predictive ability,there was no significant difference in the predictive efficiency of high level OPN and NLR 24 hours after thrombolysis for 3 months post-thrombolysis adverse outcome(AUC 0.792 Vs 0.744 P=0.5996);there was a significant difference in the predictive efficiency of OPN and OPN combined with NLR for predicting 3 months post-thrombolysis adverse outcome(AUC0.792 Vs 0.883 P=0.0325);NLR and OPN combined with NLR for predicting 3 months post-thrombolysis adverse outcome.There was a significant difference in the predictive efficiency of adverse outcomes at 3months after thrombolysis(AUC 0.744 Vs 0.883 P=0.0283).Conclusion: 1.Among ACI patients treated with thrombolysis,patients with elevated plasma OPN and NLR 24 hours after thrombolysis were more likely to have poor neurologic function at baseline and a poor prognosis at 3 months.2.Elevated plasma OPN and NLR levels at 24 hours after thrombolysis were independent risk factors for adverse outcomes after thrombolysis,and both of these factors were highly predictive of a poor prognosis at 3 months.3.Together,these 2 biomarkers may serve as important prognostic predictors of thrombolysis in patients with ACI.