Levels of Fibrin Degradation Products at Admission With Acute Ischemic Stroke Correlate With the NIH Stroke Scale Score 1 h After Intravenous Thrombolysis

Zhu, Bin; Zhang, Limin; Du, Wanliang; Yang, Jie; Tian, Yue; Wu, Mingfen; Wu, Tingxi; Ling, Xi; Liu, Yilin; Zhao, Xingquan; Zhao, Zhigang

doi:10.3389/fneur.2021.651867

Cited by 3 publications

(4 citation statements)

References 27 publications

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“…Several studies have examined the long-term prognosis of AIS following intravenous thrombolysis or biomarkers to predict intracranial bleeding, while few studies have examined the early response to r-tPA ( 31 , 32 ). In our research, a good response to thrombolysis was observed in 268 patients (38.29%), the ratio is also similar to the results of the previous studies ( 33 , 34 ). Our findings provide several novel observations.…”

Section: Discussionsupporting

confidence: 92%

Higher fibrinogen and neutrophil-to-lymphocyte ratio are associated with the early poor response to intravenous thrombolysis in acute ischemic stroke

Deng,

Song,

Tong

et al. 2024

Front. Neurol.

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BackgroundInflammation and platelet activation play pivotal roles in acute ischemic stroke (AIS) pathogenesis. Early response to thrombolysis is a vital indicator for the long-term prognosis of AIS. However, the correlation between fibrinogen or the neutrophil-to-lymphocyte ratio (NLR) and the early response to intravenous thrombolysis in patients with AIS remains unclear.MethodsAIS patients undergoing intravenous thrombolysis were enrolled between January 2018 and May 2023. Blood cell counts were sampled before thrombolysis. A good response was defined as a National Institutes of Health Stroke Scale (NIHSS) score decreased ≥4 or complete recovery 24 h after thrombolysis treatment. A poor response was defined as any increase in the NIHSS score or a decrease in the NIHSS score <4 at the 24 h after thrombolysis treatment compared with that at admission. Logistic regression analysis was performed to explore the relationship of the fibrinogen level and NLR with a poor thrombolysis response. Receiver operating characteristic (ROC) analysis was used to assess the ability of the fibrinogen level and NLR to discriminate poor responders.ResultsAmong 700 recruited patients, 268 (38.29%) were diagnosed with a good response, and 432 (61.71%) were diagnosed with a poor response to intravenous thrombolysis. A binary logistic regression model indicated that an elevated fibrinogen level (odds ratio [OR], 1.693; 95% confidence interval [CI] 1.325–2.122, P < 0.001) and NLR (OR, 1.253; 95% CI, 1.210–2.005, P = 0.001) were independent factors for a poor response. The area under the curve (AUC) values for the fibrinogen level, NLR and fibrinogen level combined with the NLR for a poor response were 0.708, 0.605, and 0.728, respectively.ConclusionsOur research indicates that the levels of fibrinogen and NLR at admission can be used as a prognostic factor to predict early poor response to intravenous thrombolysis.

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Section: Discussionsupporting

confidence: 92%

Higher fibrinogen and neutrophil-to-lymphocyte ratio are associated with the early poor response to intravenous thrombolysis in acute ischemic stroke

Deng,

Song,

Tong

et al. 2024

Front. Neurol.

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“…Nevertheless, patients in this study were not restricted to those who received IVT and the blood sample was collected within 72 h after stroke ( 26 ). Zhu et al found that the admission FDP levels correlated with the NIHSS score 1 h after IVT ( 11 ). However, they excluded patients who have large vessel occlusion and underwent endovascular thrombectomy.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies had demonstrated that increased FDP levels 2 h post-IVT were associated with PH ( 9 , 10 ). A recent study found that the admission FDP levels were negatively associated with early thrombolytic effect ( 11 ). Nevertheless, few studies focused on the relationships among the admission FDP level, PH, and the 90-day outcome after IVT in patients with AIS.…”

Section: Introductionmentioning

confidence: 99%

High Level of the Fibrin Degradation Products at Admission Predicts Parenchymal Hematoma and Unfavorable Outcome of Ischemic Stroke After Intravenous Thrombolysis

et al. 2022

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Background and PurposeWe aim to investigate whether the higher admission fibrin degradation products (FDPs) levels are associated with parenchymal hematomas (PHs) and unfavorable outcome after intravenous thrombolysis (IVT).MethodsConsecutive patients with acute ischemic stroke treated with IVT were studied. The FDP level was obtained on admission. PH was evaluated 24 h after treatment. The unfavorable outcome was defined as a 90-day modified Rankin Scale >2. The multivariable linear stepwise regression was used to assess independent factors associated with the log-transformed FDP (lgFDP). The receiver operating characteristics (ROCs) curve analysis was used to determine the predictive value of the FDP level for PH and unfavorable outcome. The logistic regression was used to identify independent predictors for PH and unfavorable outcome. The mediation analyses were performed to investigate associations among the FDP level, PH, and outcome.ResultsA total of 181 patients were included in the final analyses [median age, 73 (63–79) years; 102 (56.4%) males; and the median baseline National Institutes of Health Stroke Scale (NIHSS) score, 8 (5–15)]. The lgFDP was independently associated with age (B = 0.011, 95% CI 0.006–0.015, p < 0.001) and the baseline NIHSS score (B = 0.016, 95% CI 0.008–0.025, p < 0.001). The FDP was positively associated with PH [odds ratio (OR) 1.034, 95% CI 1.000–1.069; p = 0.047]. According to the ROC analysis, the best discriminating factor for unfavorable outcome was the FDP ≥3.085 μg/ml. The FDP ≥3.085 μg/ml was an independent predictor of unfavorable outcome (OR 7.086, 95% CI 2.818–17.822; p < 0.001). Mediation analysis revealed that the association of the FDP ≥3.085 μg/ml with unfavorable outcome was not mediated by PH (p = 0.161).ConclusionThe admission FDP levels can predict PH and unfavorable outcome in patients with acute ischemic stroke after IVT. PH does not mediate the effect of the FDP level on the outcome.

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“…We retrospectively conducted an analysis using a cohort of AIS patients who received intravenous thrombolysis with r-tPA between January 2019 and October 2020 at the Beijing Tiantan Hospital. The inclusion and exclusion criteria were previously reported by Zhu et al (2021) . Briefly, patients were recruited if they met the following criteria: diagnosis with AIS through magnetic resonance imaging or computed tomography and admittance to the emergency department within 4.5 h of symptom onset.…”

Section: Methodsmentioning

confidence: 99%

Predicting 1-Hour Thrombolysis Effect of r-tPA in Patients With Acute Ischemic Stroke Using Machine Learning Algorithm

et al. 2022

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Background: Thrombolysis with r-tPA is recommended for patients after acute ischemic stroke (AIS) within 4.5 h of symptom onset. However, only a few patients benefit from this therapeutic regimen. Thus, we aimed to develop an interpretable machine learning (ML)–based model to predict the thrombolysis effect of r-tPA at the super-early stage.Methods: A total of 353 patients with AIS were divided into training and test data sets. We then used six ML algorithms and a recursive feature elimination (RFE) method to explore the relationship among the clinical variables along with the NIH stroke scale score 1 h after thrombolysis treatment. Shapley additive explanations and local interpretable model–agnostic explanation algorithms were applied to interpret the ML models and determine the importance of the selected features.Results: Altogether, 353 patients with an average age of 63.0 (56.0–71.0) years were enrolled in the study. Of these patients, 156 showed a favorable thrombolysis effect and 197 showed an unfavorable effect. A total of 14 variables were enrolled in the modeling, and 6 ML algorithms were used to predict the thrombolysis effect. After RFE screening, seven variables under the gradient boosting decision tree (GBDT) model (area under the curve = 0.81, specificity = 0.61, sensitivity = 0.9, and F1 score = 0.79) demonstrated the best performance. Of the seven variables, activated partial thromboplastin clotting time (time), B-type natriuretic peptide, and fibrin degradation products were the three most important clinical characteristics that might influence r-tPA efficiency.Conclusion: This study demonstrated that the GBDT model with the seven variables could better predict the early thrombolysis effect of r-tPA.

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Levels of Fibrin Degradation Products at Admission With Acute Ischemic Stroke Correlate With the NIH Stroke Scale Score 1 h After Intravenous Thrombolysis

Cited by 3 publications

References 27 publications

Higher fibrinogen and neutrophil-to-lymphocyte ratio are associated with the early poor response to intravenous thrombolysis in acute ischemic stroke

Higher fibrinogen and neutrophil-to-lymphocyte ratio are associated with the early poor response to intravenous thrombolysis in acute ischemic stroke

High Level of the Fibrin Degradation Products at Admission Predicts Parenchymal Hematoma and Unfavorable Outcome of Ischemic Stroke After Intravenous Thrombolysis

Predicting 1-Hour Thrombolysis Effect of r-tPA in Patients With Acute Ischemic Stroke Using Machine Learning Algorithm

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