Data_Sheet_1_Liver function parameters aspartate aminotransferase and total protein predict functional outcome in stroke patients with non-cardioembolism.pdf

Stroke, classified as cardioembolism and non-cardioembolism (non-CE), entails a large socioeconomic burden on the elderly. The morbidity and mortality of non-CE are high, whereas studies concerning prognostic factors impacting function outcome remain underdeveloped and understudied. Liver function parameters are convenient approaches to predicting prognosis in cardiovascular diseases, but their clinical significance has not been well characterized in stroke, especially in non-CE. In our study, a total of 576 patients with non-CE at 1 year of follow-up were enrolled in a cohort from a consecutive hospital-based stroke registry, with randomly 387 patients as the development cohort and 189 patients as the validation cohort. The univariate and multivariate analyses revealed the following novel findings: (i) The incidence of unfavorable functional outcomes after non-CE was significantly greater (p < 0.01) in patients with higher age, aspartate aminotransferase (AST), the National Institutes of Health Stroke Scale (NIHSS) score, and depressed total protein (TP); (ii) We established a novel model and nomogram to predict stroke prognosis, in addition to the known factors (age and the NIHSS score). The levels of AST and TP were independently correlated with the incidence of unfavorable outcomes [AST: odds ratio (OR) = 1.026, 95% CI (1.002–1.050); TP: OR = 0.944, 95% CI (0.899–0.991)]; (iii) The results persisted in further subgroup analysis stratified by age, gender, the NIHSS score, and other prespecified factors, especially in males 60 years or older. Overall, this study demonstrates that hepatic parameters (AST and TP) after non-CE are considered to be associated with functional outcomes at 1-year follow-up, especially in males aged ≥ 60 years.

脑卒中可分为心源性栓塞型（cardioembolism）与非心源性栓塞型（non-cardioembolism，简称non-CE），给老年群体带来了沉重的社会经济负担。非心源性栓塞型脑卒中的发病率与死亡率均处于较高水平，但目前针对影响其功能预后的危险因素的相关研究仍较为匮乏。肝功能指标是心血管疾病预后预测的便捷检测手段，但在脑卒中领域，尤其是非心源性栓塞型脑卒中中，其临床意义尚未得到充分阐明。本研究从一项连续性医院脑卒中登记库中纳入了576例完成1年随访的非心源性栓塞型脑卒中患者，随机将其中387例设为建模队列，剩余189例设为验证队列。单因素与多因素分析得出了以下全新发现：(i) 年龄更高、天冬氨酸氨基转移酶（aspartate aminotransferase, AST）水平偏高、美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale, NIHSS）评分更高以及总蛋白（total protein, TP）水平降低的非心源性栓塞型脑卒中患者，其不良功能预后发生率显著更高（p < 0.01）；(ii) 本研究在年龄与NIHSS评分等已知预后因素的基础上，构建了一款全新的脑卒中预后预测模型及列线图（nomogram），其中AST与TP水平与不良预后发生率独立相关[AST：比值比（odds ratio, OR）=1.026，95%置信区间（confidence interval, CI）：1.002–1.050；TP：OR=0.944，95%CI：0.899–0.991]；(iii) 按年龄、性别、NIHSS评分及其他预设因素进行的亚组分析进一步验证了上述结果，尤其是在60岁及以上的男性患者中。综上，本研究表明，非心源性栓塞型脑卒中患者的肝功能指标（AST与TP）与1年随访期内的功能预后存在显著关联，这一关联在60岁及以上的男性患者中尤为突出。