Relationship Between Helicobacter Pylori Infection And Poor Prognosis Of Ischemic Stroke

ObjectiveAcute Ischemic Stroke(AIS)has become one of the major disease affecting the health and quality of life of residents.Helicobacter pylori(Hp)infection can promote the progression of atherosclerosis,and it is related to the important risk factors for the adverse prognosis of ischemic stroke,such as hypertension,insulin resistance and dyslipidemia.Hp infection can increase the risk of AIS,but there is a paucity of study regarding Hp infection and the prognosis of ischemic stroke,and the research findings are inconsistent.We conducted a multi-center cohort study in 14 hospitals in China,included the patients with first-onset AIS,and quantitative measured the serum anti-Hp-Ig G levels on admission,to analyze the relationship between Hp-Ig G level and one-year adverse prognosis of AIS and its subtypes.Subjects and methods1.Subjects: From June 2011 to December 2013,total 1150 patients were recruited with first onset of AIS,admission within 72 hours,age ? 40 years old,from 14 hospitals in seven provinces.AIS was diagnosed by neurologists with standard diagnostic procedures according to CT or MRI(magnetic resonance images).2.Baseline information: We collected information from patients or relatives with questionnaire by face to face.The main investigation contents include demographic data,lifestyle,disease history etc.Clinical data include heart rate,electrocardiograph(ECG),blood pressure,National Institutes of Health Stroke Scale(NIHSS)score evaluation and treatment in hospital.After the patients were enrolled,venous blood was collected and the plasma was isolated and stored in the ultra-low temperature refrigerator.General hematology examination are conducted at local hospitals,Hp-Ig G antibody concentration was uniformly detected by the automatic enzyme-linked immunoassay analyzer(Freedom EVOlyzer 150/8)in Inner Mongolia Xing'an Meng Hospital.3.Research methods: A corhot study was used to evaluate the relationwhip between concentration of Hp-Ig G and poor prognosis outcomes at 1 year after AIS onset.Poor prognosis outcomes were accessed by research outcomes and composite outcomes.Research oucomes are include all-cause death(abbreviated death),cardiovascular events and death from cardiovascular disease(referred to as cardiovascular death).The composite outcome includes the composite outcome of death or cardiovascular events and the composite outcome of death and severe disability(the m RS scale score 3-6,for short,death and disability).4.Statistical methos: Analysis was performed using software SAS 9.4,and the survival curve was plotted using SPSS 19.0.All patients were divided into four groups of G1(?P25),G2(<P25-P50),G3(<P50-P75),and G4(>P75)according to the quartiles of Hp-Ig G concentration at baseline.Univariate and multifactor adjusted Cox regression models or Logistic regression models were established to analyze the relationship between Hp-Ig G levels and the risk of different prognostic outcomes at 1 year after the onset of AIS.Hp-Ig G of AIS subtypes were divided into low-level group(?P50)and high-level group(>P50)according to the median of Hp-Ig G at baseline.In each subtype AIS,univariate and multifactor adjusted Cox regression models or Logistic regression models were established to analyze the relationship between Hp-Ig G levels and the risk of prognostic outcomes.The area under the ROC curve(AUC)was calculated to assess predictive value of the Hp-Ig G index on poor outcome events of AIS.In addition,AUC,net reclassification improvement(NRI)and integrated discrimination improvement(IDI)were calculated to evaluate the predictive value of adding Hp-Ig G index to conventional risk factors.Results1.The study included a total of 1150 first-onset AIS cases.The mean age was 62.39±11.19 years,with 787 men(68.43%)and 363 women(31.57%).The median(IQR)of NIHSS score was 5(3,8)on admission,and the median(IQR)of Hp-Ig G was 10.14(7.39,15.05)ng/L within 24 hours after admission.In this study,there were 559 cases of Large artery atherosclerosis(LAA),358 cases of Small artery occlusion lacunay(SAA)and 65 cases of Cardioembolism(CE).2.In Cox regression model,after adjustment for multiple factors,the risk of all-cause death and cardiovascular death increased in G4 group compared to the G1 group,and the HR(95%CI)was 3.43(1.26-9.36)and 5.45(1.57-18.90),respectively;the G3 group had higher risk of cardiovascular events compared to G1 group,and the HR(95%CI)was 2.02(1.02-3.98);the risk of death or cardiovascular events increased in G2,G3 and G4 group compared to G1 group,and the HR(95%CI)was 1.84(1.02-3.34)?2.00(1.12-3.56)and 1.97(1.10-3.55),respectively.Trend test showed with the level of Hp-Ig G increased,the risk of death,cardiovascular death and death or cardiovascular events increased in AIS at 1 year after onset(P<0.05).3.In Cox regression model,after adjustment for multiple factors,compared to low level of Hp-Ig G in LAA cases,the risk of death,cardiovascular death and death or cardiovascular events increased in LAA cases with high level Hg-Ig G,and the HR(95%CI)was 2.69(1.13-6.39),3.11(1.13-8.53)and 1.92(1.12-3.31),respectively.Before or after adjusting multiple factors,the interaction between Hp-Ig G level and stroke subtype has no statistical significance for each poor outcome(P>0.05).4.The result of AUC showed Hp-Ig G as categorical and continuous indicators have predictive value on risk of death,cardiovascular death,and death or cardiovascular events within one-year after onset of AIS.Besides,adding Hp-Ig G as categorical and continuous indicators to the model containing conventional risk factors improved predictive capability for risk of death and cardiovascular death within one-year after onset of AIS.Conclusion1.The antibody level of Hp is a risk factor for adverse prognosis of acute ischemic stroke.Higher level of Hp-Ig G could increase the risk of death,cardiovascular death,and death or cardiovascular events at one year after AIS onset.2.In LAA cases,high level of Hp-Ig G could increase the risk of death,cardiovascular death,and death or cardiovascular events at one year after AIS onset.3.Among different subtype of AIS,the level of Hp-Ig G has consistent effect on AIS poor prognosis.4.Hp-Ig G Index has predictive value on the risk of poor prognosis of AIS.Adding Hp-Ig G Index to conventional risk factors can improve risk prediction for the risk of adverse prognosis of AIS.