Association Between the Serum Iron and Acute Cognitive Impairment After Stroke: A Cross-Sectional Study.

BACKGROUND: Complications such as cognitive impairment are common in stroke victims. The goal of this study was to see if there was a link between blood iron levels and post-stroke cognitive impairment (PSCI) within 2 weeks after stroke. METHODS: A total of 313 patients with ischemic stroke were recruited and separated into two groups: PSCI (n = 202) and non-PSCI (n = 111). The Mini-mental state examination scale was used to evaluate the cognitive status within 2 weeks after stroke (acute phase). The serum iron levels were divided into 4 layers: Q1 ≤ 11.7 µmol/L, Q2 11.8-15.1 µmol/, Q3 15.2-19.3 µmol/L, Q4 ≥ 19.4 µmol/L, respectively. The connection between serum iron and PSCI was then investigated further using binary logistic regression, which was adjusted for confounders. RESULTS: The difference in serum iron levels between the PSCI and non-PSCI group was initially conducted by the Mann-Whitney test, and a significant difference was found (14.5 (11.0-17.8) vs. 16.9 (13.7-21.8), p < .001), with no confounders being adjusted. After adjusting for confounding factors, the binary regression analysis showed that the Q4 layer showed the lowest risk of PSCI, with the Q1 layer being the reference. (odds ratio (OR) = 0.297, 95% confidence interval (CI) = 0.136-0.649, p = 0.002). CONCLUSION: A decreased risk of early-onset PSCI was linked to high serum iron levels. Low serum iron levels were found to be a risk factor for acute cognitive impairment following stroke, which could help physicians identify and take intervention measures early to reduce the risk of cognitive impairment after stroke.

The HALP (hemoglobin, albumin, lymphocyte, and platelet) score is associated with early-onset post-stroke cognitive impairment.

BACKGROUND: The HALP score (hemoglobin, albumin, lymphocyte, and platelet) is a novel indicator that measures systemic inflammation and nutritional status. The goal of this study was to look into the relationship between the HALP score and post-stroke cognitive impairment (PSCI) in people who had an acute ischemic stroke (AIS). METHODS: A total of 592 individuals with ischemic stroke were included in the research, and the PSCI (n = 382) and non-PSCI (n = 210) groups were determined using the Mini-Mental State Examination scale 2 weeks following the stroke. HALP score was computed by the formula: hemoglobin (g/L) × albumin (g/L) × lymphocytes (/L) / platelets (/L), and was split into three layers according to the tertiles. The connection between the HALP and cognitive results was investigated by binary logistic regression. RESULTS: The PSCI group's HALP score was much lower than the non-PSCI group's (p < 0.001). The HALP score was divided into three layers: T1 ≤ 34.0, T2 34.1-49.4, and T3 ≥ 49.5, respectively. In the binary regression analysis, taking the T3 layer as the reference, the T1 layer showed the highest risk of PSCI after adjusting for confounding factors (odds ratio (OR) = 1.965, 95% confidence interval (CI) = 1.237-3.122, p = 0.004), while there was no increased risk of PSCI in the T2 layer (OR = 1.538, 95%CI = 0.983-2.404, p = 0.059). CONCLUSION: Low HALP score at admission was found to be correlated with early-onset PSCI and may help clinicians in the early identification of high-risk patients.

Lactate Dehydrogenase Predicts Hemorrhagic Transformation in Patients with Acute Ischemic Stroke.

INTRODUCTION: Hemorrhagic transformation (HT) is a severe but frequent complication of acute ischemic stroke (AIS). This study aimed to evaluate the relationship between serum lactate dehydrogenase (LDH) levels and HT. METHODS: We retrospectively included 542 AIS patients with HT and 1,091 age- and gender-matched patients without HT. Demographic and clinical data were obtained from medical records, and blood samples were obtained within 24 h after admission. The characteristics of the groups were compared. With the receiver operating characteristic (ROC) curve analysis, we assessed the discriminating capacity of LDH levels in predicting HT in patients with AIS. The logistic regression model was used to determine the connection between LDH and HT. RESULTS: The HT group had considerably higher LDH levels than the non-HT group (263.0 [216.0-323.3] U/L versus 178.0 [162.0-195.0] U/L, p < 0.001). We also observed that the levels of LDH in the parenchymal hemorrhage subgroup were significantly higher than those in the hemorrhagic infarction subgroup (281.0 [230.0-340.0] U/L versus 258.0 [209.0-311.0] U/L, p < 0.001). The area under the ROC curve of LDH was 0.890 (95% confidence level [CI] 0.874-0.905, p < 0.001). Besides, logistic regression revealed that high LDH levels (LDH >215 U/L) showed a higher risk of HT (odds ratio = 10.958, 95% CI 7.964-15.078, p < 0.001). CONCLUSION: High LDH levels were linked with an increased risk of HT in AIS patients. Practical measures should be considered in patients with increased LDH levels (LDH >215 U/L).

Predictive Ability of Systemic Inflammation Response Index for the Risk of Pneumonia in Patients with Acute Ischemic Stroke.

INTRODUCTION: Several studies have examined the crucial role of inflammatory indexes such as the ratio of monocyte and lymphocyte (MLR), systemic-immune-inflammation-index, and the ratio of neutrophil and lymphocyte (NLR) in stroke-associated pneumonia (SAP). However, the function of the systemic inflammation response index (SIRI) in SAP is not known. This study investigated whether SIRI at admission could predict the incidence of SAP in patients with acute ischemic stroke (AIS). PATIENTS AND METHODS: 2,802 AIS patients collected from 2013 to 2021 were divided into the SAP and non-SAP groups. The predictive performance of SIRI in SAP was evaluated by the receiver operating characteristic curve. Multivariate regression analysis and the restricted cubic spline (RCS) were performed to explore the relationship between SIRI and SAP risk. RESULTS: The SIRI at admission in SAP patients was significantly higher than that in non-SAP patients (median [IQR]: 3.75 [2.05, 6.99] vs. 1.51 [0.94, 2.62], p < 0.001). SIRI had a predictive ability for predicting the incidence of SAP with area under the curve of 0.757, better than NLR and MLR (both p < 0.05). SIRI ≥2.74 was an independent risk factor for the incidence of SAP (odds ratio: 5.82, 95% confidence interval: 4.54, 7.49, p < 0.001). The RCS model showed an increasing trend of the SAP risk with the increase of SIRI. CONCLUSION: SIRI showed a good predictive value for SAP. In clinical practice, AIS patients with high SIRI levels (SIRI ≥2.74) should be aware of the risk of SAP.

Low triiodothyronine syndrome is associated with stroke-associated pneumonia.

OBJECTIVE: Stroke-associated pneumonia (SAP) is the most common early consequence in patients suffering from an acute ischaemic stroke (AIS). The purpose of this study was to explore the possible relationship between low triiodothyronine (T3) syndrome and SAP in stroke patients. METHODS: This study recruited 2460 consecutive AIS patients. SAP was defined according to the modified Centers for Disease Control and Prevention criteria for hospital-acquired pneumonia. The thyroid hormones levels were measured within 24 h after admission. Low T3 syndrome was characterized as T3 below the lower limit of the reference interval accompanied by normal TSH levels. RESULTS: Among the total patients, 336 (13.7%) patients were diagnosed with SAP. SAP in individuals with low T3 syndrome was substantially greater (p < .001) as compared to those without low T3 syndrome. After adjusting for possible confounders, low T3 syndrome (adjusted odds ratio [aOR] = 1.59; 95% confidence interval [CI], 1.20-2.09; p = .001) remained significant in our logistic model. Patients with low T3 syndrome had a higher risk of severe SAP (aOR = 2.17, 95% confidence interval [CI] 1.38-3.44; p = .001). CONCLUSION: Low T3 syndrome, independent of recognized risk factors, is a possible risk factor for in-hospital SAP, which can help clinicians in the early detection and treatment of high-risk patients.

Uric acid played a role in the association between gender and deep vein thrombosis in patients with stroke.

BACKGROUND AND AIMS: Gender-specific differences were found in serum uric acid (SUA) levels and the risk of isolated distal deep vein thrombosis (IDDVT). This study aimed to explore the association among gender, SUA, and IDDVT in stroke patients. METHODS AND RESULTS: Finally, 3404 patients were recruited and divided into two groups: IDDVT (n = 1233) and Non-IDDVT (n = 2171) groups. Propensity score matching (PSM) was conducted to match the patients. Binary logistic regression was adopted to explore the association between SUA and IDDVT, with the SUA divided into quartiles. After PSM, 975 patients were included in each group. Non-IDDVT group had a larger proportion of male than IDDVT group (64.9% vs. 52.7%, p < 0.001). Moreover, males showed higher SUA levels than females (316.7 ± 102.1 vs. 261.8 ± 94.0 µmol/L, t = 12.1, p < 0.001). The highest quartile of SUA (≥346 µmol/L) showed a lower risk of IDDVT (OR = 0.629, p = 0.001), while the lowest quartile (≤225 µmol/L) showed a higher risk of IDDVT (OR = 1.361, p = 0.022). CONCLUSION: In patients with stroke, SUA played a protective role in IDDVT. Females had a higher risk of IDDVT, which may be owing to the lower SUA levels than males. In clinical practice, more attention should be paid to the risk of IDDVT in females, especially those with lower SUA levels.

The association between interleukin-8 levels and the development of withdrawal symptoms during methamphetamine abstinence.

OBJECTIVE: Withdrawal symptoms are common during methamphetamine (METH) abstinence. This study aimed to explore the association between serum interleukins and withdrawal symptoms during METH abstinence. METHODS: This study recruited 120 METH users, and 94 of them completed the 2-week follow-up. Serum interleukin-1ß, 6,8,10 were tested at admission. Withdrawal symptoms were assessed by the Methamphetamine Withdrawal Questionnaire (MAWQ). RESULTS: Serum IL-8 levels were positively correlated with MAWQ scores at the 2-week endpoint (r = .257, p = .013). The variation of the MAWQ scores during the 2-week follow-up was negatively correlated with serum IL-8 levels at admission (r = -.249, p = .026). Serum IL-8 levels remained associated with the severity of METH withdrawal symptoms (ß = .363, p = .023), after adjusting for potential confounders. LIMITATIONS: This study did not include normal controls. Most patients were male and cigarette smokers. Patients were only followed up for 2 weeks, and their toxicology data were not collected. Interleukins were only measured at admission, and were tested in serum, not in the cerebrospinal fluid. CONCLUSIONS: Our study demonstrated that higher serum IL-8 levels may predict more severe withdrawal symptoms at 2 weeks after METH abstinence.

Impact of prediabetes on poststroke depression in Chinese patients with acute ischemic stroke.

OBJECTIVE: It is unknown whether prediabetes is a predictor of poststroke depression (PSD). We aimed to explore the relationship between prediabetes and PSD in Chinese patients with acute ischemic stroke. METHODS: This is a prospective cohort study, and a total of 358 patients with acute ischemic stroke were recruited and enrolled. Patients were divided into 3 groups: normal glucose group (NGT, n = 96), prediabetes group (preDM, n = 134, impaired fasting glucose (IFG), and/or impaired glucose tolerance (IGT) and/or HbA1c (A1c) 5.7%-6.4%), and the diabetes mellitus group (DM, n = 128). At 1 month after stroke, patients with a Hamilton Depression Scale score of ≥8 were diagnosed as PSD. RESULTS: In post hoc comparisons, the risk of PSD in patients with diabetes and prediabetes was higher than patients with NGT (37.5% vs 31.3% vs 14.6%, P = .001). Compared with NGT, the incidence rate of PSD in patients with prediabetes with HbA1c 5.7% to 6.4% and patients with prediabetes with IFG/IGT + HbA1c 5.7% to 6.4% was higher (35.3% vs 14.6%, 38.0% vs 14.6%; P = .006; P = .003, respectively). In logistic regression, prediabetes with HbA1c 5.7% to 6.4% and prediabetes with IFG/IGT + HbA1c 5.7% to 6.4% were a significant independent predictor of PSD after adjusting for potential confounding factors, with odd ratios of 1.731 and 1.978, respectively. CONCLUSIONS: Our study showed that prediabetes was associated with PSD and may predict its development at 1 month poststroke. In prediabetes subgroups, patients with HbA1c 5.7% to 6.4% were more likely to develop PSD compared to NGT and IFG/IGT groups.

Impact of seasons on stroke-related depression, mediated by vitamin D status.

BACKGROUND: This study aimed to describe the seasonal variation of depression prevalence among stroke patients at 1 month and to explore whether vitamin D plays a role in the association between seasons and post-stroke depression (PSD). METHODS: Data were collected from 402 acute stroke patients. Seasons were stratified by summertime (June to November) and wintertime (December to May) based on vitamin D status. The impact of seasons on PSD was assessed via binary logistic regression, with summertime considered the referent category. The mediating effect was used to evaluate whether vitamin D plays a role in the association between seasons and PSD. RESULTS: The prevalence of PSD was significantly higher in the wintertime group than in the summertime group (P = 0.003). The serum vitamin D level was lower in wintertime than in summertime (P < 0.001). Lower vitamin D levels were associated with higher HAMD scores (P < 0.001). In the multivariate analysis, patients in the wintertime group had a higher prevalence of PSD compared with those in the summertime group across all binary logistic regression models after adjusting for potential confounders. When serum vitamin D was added to the above model, there was no association between seasons and PSD (P = 0.056). Vitamin D was independently associated with PSD (OR 0.95, 95% CI 0.935-0.966, P < 0.001). CONCLUSION: There was a clear seasonal variation in depression prevalence among stroke patients. Vitamin D status plays a critical mediating role in the relationship between season and post-stroke depression.

The effect of cigarette smoking on vitamin D level and depression in male patients with acute ischemic stroke.

OBJECTIVE: The association between low vitamin D levels and depression has been well documented in nonstroke subjects. Accumulating evidence shows that low vitamin D levels may be also associated with depression post stroke. Cigarette smoking was associated with lower vitamin D levels. The purposes of this study were to compare vitamin D levels in smokers to nonsmokers and examine the association between vitamin D levels and depression symptoms in patients with acute ischemic stroke. MATERIALS AND METHODS: Serum levels of 25-hydroxyvitamin D [25(OH)D] were measured in 194 males within 24h after admission: 116 smokers and 78 nonsmokers. Depression symptoms were assessed with the 17-item Hamilton Depression Scale (HAMD-17). Patients with the HAMD-17 score >7 were identified to have depression symptoms. RESULTS: The chi-square test showed that the frequency of depression in the smoker group was 23.3% (27/116), which was significantly higher than that in the nonsmoker group (11.5%=9/78), with an odds ratios (OR) of 2.33 (95% CI: 1.03-5.27; χ(2)=4.25, df=1, p=0.039, φ=0.15). Vitamin D levels were significantly lower in smokers than in nonsmokers (52.4±20.8 vs 61.7±19.2; F=9.88, p=0.002), with an effect size of 0.05 (ηp(2)). Patients with depression symptoms showed lower vitamin D levels than those with no depression symptoms (49.2±19.6 vs 57.7±20.6; F=5.03, p=0.03), with an effect size of 0.03 (ηp(2)). CONCLUSION: Higher rates of depression in smokers with acute ischemic stroke may be associated with lower vitamin D levels induced by smoking.

Mercury biomagnification in subtropical reservoir fishes of eastern China.

Little is known about mercury (Hg) biomagnification in the subtropics, aquatic systems with high species diversity resulting in complex food webs. High atmospheric Hg emissions and ubiquitous reservoir fisheries may lead to elevated Hg bioaccumulation in Chinese freshwater fishes. However, stocking practices using fast-growing species can result in low fish total Hg (THg) concentrations. Here, we describe Hg transfer within the fish food web of a large subtropical reservoir, Qiandao Hu (Xin'anjiang reservoir) situated in eastern China. We measured food web Hg biomagnification and THg concentrations in 33 species of stocked and wild fishes. Mercury concentrations in most fishes were low, though we also found high Hg concentrations in wild top predators. The food web structure, assessed using stable isotopes of carbon (δ(13)C) and nitrogen (δ(15)N), demonstrated a high degree of omnivory and a long food chain. THg concentrations were highly correlated with fish δ(15)N values. The regression of log10THg against δ(15)N revealed the overall Hg biomagnification rate was low. This study shows that where long food chains exist in subtropical reservoirs, elevated Hg accumulation in top predators can occur despite a low Hg biomagnification rate.

Altered functional connectivity in patients with post-stroke fatigue: A resting-state fMRI study.

BACKGROUND: Post-stroke fatigue (PSF) was a common complication after stroke. This study aimed to explore the neuroimaging mechanism of PSF, which was rarely studied. METHODS: Patients with the first episode of ischemic stroke were recruited from the First Affiliated Hospital of Wenzhou Medical University between March 2021 and December 2022. The fatigue severity scale (FSS) was used to assess fatigue symptoms. PSF was diagnosed by a neurologist based on the FSS score and PSF diagnostic criteria. All the patients were scanned by resting-state functional MRI (rs-fMRI). Precuneus, the posterior node of default-mode network (pDMN), was related to fatigue. Therefore, imaging data were further analyzed by the seed-based resting-state functional connectivity (FC) approach, with the left (PCUN.L) and right precuneus (PCUN.R) being the seeds. RESULTS: A total of 70 patients with acute ischemic stroke were finally recruited, comprising 40 patients with PSF and 30 patients without PSF. Both the PCUN.L and PCUN.R seeds (pDMN) exhibited decreased FC with the prefrontal lobes located at the anterior part of DMN (aDMN), and the FC values were negatively correlated with FSS scores (both p < 0.001). These two seeds also exhibited increased FC with the right insula, and the FC values were positively correlated with FSS scores (both p < 0.05). CONCLUSION: The abnormal FC between the aDMN and pDMN was associated with PSF. Besides, the insula, related to interoception, might also play an important role in PSF.

Clinical significance of albumin to globulin ratio among patients with stroke-associated pneumonia.

Background: It has been proven that the ratio of albumin to globulin (A/G) is a typical biomarker for monitoring inflammation and nutritional status. But the potential role of A/G in stroke-associated pneumonia (SAP) after acute ischemic stroke (AIS) remained unknown. Patients and methods: Following inclusion criteria, 5,173 AIS patients were included and segmented into SAP (n = 897) and non-SAP (n = 4,276) groups. The differences in variables between groups were compared. The logistic regression model was used to determine the association between A/G and SAP, and a forest plot was drawn. Results: Compared with the non-SAP group, the SAP group had a lower A/G level (P < 0.001). Then, A/G was divided into quartiles. In comparison to Q3 (A/G = 1.25-1.39), logistic regression revealed that patients with a lower A/G (A/G ≤ 1.09) had a higher risk of SAP (OR = 1.96, 95% CI, 1.56-2.46, P < 0.001). On the contrary, those with a higher A/G (A/G ≥ 1.4) had a lower SAP risk (OR = 0.73, 95% CI, 0.54-0.97, P = 0.029). Conclusion: The study revealed that a low A/G level was associated with an increased SAP risk. Appropriate preventative measures for SAP should be taken in AIS patients with a low A/G level.

Geriatric Nutritional Risk Index is related to the risk of stroke-associated pneumonia.

BACKGROUND: Stroke-associated pneumonia (SAP) occurs frequently after a stroke. Geriatric Nutritional Risk Index (GNRI) is a valuable indicator of elderly individuals' nutritional status. This research was designed to obtain insight into the link between GNRI and SAP. METHODS: Patients with acute ischemic stroke (AIS) were categorized into the SAP and non-SAP groups. GNRI scores were divided into four layers: Q1, GNRI < 82; Q2, 82≤ GNRI < 92; Q3, 92≤ GNRI ≤98; Q4, GNRI > 98. To identify the independent risk and protective factors of developing SAP, logistic regression analyses were conducted. Additionally, we utilized the restricted cubic spline (RCS) analysis to test the effect of GNRI on the SAP risk. RESULTS: The SAP group showed lower GNRI scores than the non-SAP group (96.88 ± 9.36 vs. 100.88 ± 8.25, p  <  0.001). According to the logistic regression model, the Q1 and Q2 layers showed a higher risk of SAP than the Q3 layer, while the Q4 layer showed a lower SAP risk (all p < 0.05). Besides, the RCS model found that the risk of SAP dropped dramatically as GNRI scores increased, which got stable when the GNRI score was more significant than 100. CONCLUSION: Lower GNRI scores were linked to a higher prevalence of SAP. In clinical practice, GNRI showed predictive value for SAP, which could be helpful in early SAP intervention and therapy.

Glucose to Platelet Ratio: A Potential Predictor of Hemorrhagic Transformation in Patients with Acute Ischemic Stroke.

Glucose and platelet are two easily obtained clinical indicators; the present research aimed to demonstrate their association with hemorrhagic transformation (HT) in acute ischemic stroke (AIS) patients without thrombolytic or thrombectomy therapy. This was a single-center retrospective study. Patients who were diagnosed with HT after AIS were included in the HT group. Meanwhile, using the propensity score matching (PSM) approach, with a ratio of 1:2, matched patients without HT were included in the non-HT group. Serum G/P levels were measured on the first morning after admission (at least eight hours after the last meal). Characteristics were compared between the two groups. Multivariate logistic regression was used to determine the independent relationship between G/P and HT after AIS, with G/P being divided into quartiles. From January 2013 to March 2022, we consecutively included 643 AIS patients with HT (426/643 [66.25%] with HI and 217/643 [33.75%] with PH), and 1282 AIS patients without HT, at the First Affiliated Hospital of Wenzhou Medical University. The HT group had higher G/P levels than the non-HT group (0.04 ± 0.02 vs. 0.03 ± 0.02, p < 0.001). However, there was no difference in G/P levels between HI and PH subgroups (0.04 ± 0.02 vs. 0.04 ± 0.02, p > 0.05). Moreover, the G/P levels were divided into quartiles (Q1 ≤ 0.022; Q2 = 0.023−0.028; Q3 = 0.029−0.039; Q4 ≥ 0.040), with Q1 being settled as the reference layer. After controlling the confounders, multivariate regression analyses showed that the Q4 layer (Q4: G/P ≥ 0.040) was independently associated with elevated HT risk (odds ratio [OR] = 1.85, 95% CI = 1.31−2.63, p < 0.001). G/P levels on admission were independently associated with HT risk in AIS patients. In clinical practice, adequate attention should be paid to AIS patients with elevated G/P levels (G/P ≥ 0.040).

Higher Stress Hyperglycemia Ratio Is Associated With a Higher Risk of Stroke-Associated Pneumonia.

Objective: Stroke-associated pneumonia (SAP) is a frequent complication in stroke patients. This present study aimed to investigate the association between stress hyperglycemia and SAP. Methods: Patients were screened between February 2013 and August 2020 from the First Affiliated Hospital of Wenzhou Medical University. We divided the blood glucose of the patients at admission by the glycated hemoglobin to calculate the stress hyperglycemia ratio (SHR). Binary logistic regression analysis was used to identify the association between SAP and SHR, with the confounders being controlled. Further, subgroup analyses were separately performed for stroke patients with and without diabetes. Results: A total of 2,039 patients were finally recruited, of which 533 (26.14%) were diagnosed with SAP. SHR were divided into four quartiles in the logistic regression analysis, the highest SHR quartile (SHR ≥ 1.15) indicated a higher risk of SAP (OR = 1.57; 95% CI = 1.13-2.19, p = 0.01) in total patients. In patients without diabetes, the third quantile (SHR = 0.96-1.14) and the highest quantile (SHR ≥ 1.15) were both related to a higher risk of SAP (both p < 0.05). However, we did not find such an association in diabetic patients. Conclusion: SHR was significantly associated with the risk of SAP in patients without diabetes. Adequate attention should be paid to the patients with high SHR levels at admission, especially those without diabetes.

Serum Uric Acid Levels at Admission Could Predict the Chronic Post-stroke Fatigue.

Background: Post-stroke fatigue (PSF) is a frequent complication of stroke. Serum uric acid (SUA) is frequently thought to be a risk factor for stroke. This study aimed to investigate whether SUA also played a role in PSF. Methods: Subjects with ischemic stroke were screened from The First Affiliated Hospital of Wenzhou Medical University between January 2020 and October 2020. Patients' fatigue symptoms were assessed by the Fatigue severity scale (FSS). To investigate the relationship between SUA and PSF, binary logistic regression analysis was conducted, with the confounders being controlled. SUA levels were divided into four layers (Q1 ≤ 245 µmol/L; Q2 246-308 µmol/L; Q3 309-365 µmol/L; Q4 ≥366 µmol/L) based on the quartiles. Results: SUA levels were significantly higher in the PSF group (345.96 ± 73.78 µmol/L) than the non-PSF group (295.97 ± 87.8 µmol/L, P < 0.001). There were no differences in any other variables between these two groups. After adjusting the confounders, the risk of PSF in the Q4 layer (≥366 µmol/L) was 6.05 times (95% CI 1.79-20.43, P = 0.004) higher than that in Q1 (≤245 µmol/L). Conclusion: High SUA at admission was an independent risk factor for fatigue 1 year after stroke onset. High SUA (≥366 µmol/L) during stroke deserves more attention, and active control of high SUA levels may be beneficial to reduce the incidence of PSF in the chronic stage following stroke.

An L-Shaped Relationship Between Serum Iron and Stroke-Associated Pneumonia.

OBJECTIVE: Pneumonia is a common complication in patients with stroke. There was a close relationship between serum iron and inflammatory response. This study aimed to explore the relationship between serum iron levels and stroke-associated pneumonia (SAP). METHODS: Patients with acute stroke were recruited from the First Affiliated Hospital of Wenzhou Medical University and divided into SAP group and Non-SAP group. The demographic and clinical data of the patients were collected via the medical records, and the blood samples were collected within 24 hours after admission. The predictive value of serum iron to SAP was evaluated by receiver operating characteristic curve (ROC) and binary Logistic regression models. A restricted cubic spline (RCS) was used to furtherly clarify the relationship between serum iron and the risk of SAP. RESULTS: A total of 906 participants were enrolled, including Non-SAP group (n = 755) and SAP group (n = 151). Serum iron levels in the SAP group were significantly lower than those in the Non-SAP group (9.77±5.61 vs 14.01±6.80, P < 0.001). Logistic regression showed that patients with high serum iron levels (≥7.8µmol/L) showed a lower risk of SAP (OR=0.43, 95% CI, 0.27-0.69, P < 0.001). Besides, the RCS model showed that there was an L-shaped relationship between the serum iron and risk of SAP (P for non-linearity: 0.014). CONCLUSION: Low serum iron level was a risk factor for SAP, and there was an L-shaped relationship between them. Stroke patients with low serum iron levels should be alert to the risk of SAP.

Lactic Dehydrogenase to Albumin Ratio Is Associated With the Risk of Stroke-Associated Pneumonia in Patients With Acute Ischemic Stroke.

Background: Stroke-associated pneumonia (SAP) is one of the common complications of stroke patients. Higher lactic dehydrogenase (LDH) and lower albumin levels were associated with SAP, but the contribution of the LDH to albumin ratio (LAR) to the risk of SAP in acute ischemic stroke (AIS) patients remained unclear. Methods: A total of 3173 AIS patients were included in this study, divided into SAP (n = 417) and non-SAP groups (n = 2756). Characteristics were compared between these two groups. The receiver operating characteristic curves (ROC) were used to evaluate the discrimination ability of the LAR, LDH, and albumin levels in predicting SAP. Logistic regression analysis was furtherly adopted to estimate the association between LAR and SAP. We also used the restricted cubic spline (RCS) to clarify the relationship between LAR and the risk of SAP. Results: LAR in the SAP group was significantly higher than that of the non-SAP group (8.75 ± 4.58 vs. 6.10 ± 2.55, P < 0.001). According to the results of ROC, LAR had the highest prognostic accuracy compared to LDH and albumin (P < 0.05). Besides, the logistic regression model showed that higher LAR (LAR > 6.75) were more vulnerable to SAP (OR, 2.80; 95% CI, 2.18-3.59, P < 0.001), controlling the confounders. The RCS model showed that there was a non-linear relationship between LAR and the risk of SAP. Conclusion: High LAR was associated with an increased risk of SAP in patients with AIS. LAR may be a potential predictor for the incidence of SAP. Appropriate prevention measures were needed in patients with high LAR (LAR > 6.75).