Construction of a prediction model of adverse prognosis risk of urokinase intravenous thrombolysis in ACI patients and the prediction value of serum PPAR-γ and leptin levels

Na Chen; dali xue; junbo wang; lijing zhao

doi:10.18282/po4763

Na Chen Department of Neurology, the Second Affiliated Hospital of Xingtai Medical University, Xingtai, Hebei, China 054000
dali xue Department of Neurology, the Second Affiliated Hospital of Xingtai Medical University, Xingtai, Hebei, China 054000
junbo wang Department of Interventional Vascular Surgery, the Second Affiliated Hospital of Xingtai Medical University, Xingtai, Hebei, China 054000
lijing zhao ^* Department of Neurology, the Second Affiliated Hospital of Xingtai Medical University, Xingtai, Hebei, China 054000

Article ID: 4763

Abstract

Objective To explore the risk factors influencing the poor prognosis of urokinase intravenous thrombolysis in patients with acute cerebral infarction (ACI), analyze the predictive value of serum PPAR-γ and leptin levels, and construct an effective predictive model. Methods One hundred patients with ACI who received urokinase intravenous thrombolysis in our hospital from November 2020 to December 2021 were selected as the research subjects, and the clinical data were collected and retrospectively analyzed. All patients were followed up for three months, and the prognosis of the patients was evaluated according to the modified Rankin scale (mRS) score, and those with mRS score ≥4 were included in the poor prognosis group (n=28). Those with an mRS score less than 4 points were included in the good prognosis group (n=72). The risk factors influencing the poor prognosis of patients with ACI were screened using 2-test and t-test, and the high risk factors were identified through the logstic regression model, and a prediction model was constructed. The risk factors and the prediction efficiency of the prediction model on the poor prognosis of patients were analyzed through the ROC. Results The incidence of poor prognosis in ACI patients treated with thrombolytic therapy with urokinase was 28.00%, and the proportion of patients in the poor prognosis group who were accompanied with atrial fibrillation, the time from onset to intravenous thrombolysis > 4.5h, and NIHSS score > 10 before thrombolysis was significantly higher than that in the control group (P < 0.05). The serum the levels of PPAR-γ and Leptin in the poor prognosis group were higher than those in the good prognosis group (both P < 0.05). Logistic regression analysis showed that combined atrial fibrillation, NIHSS score > 10 before thrombolysis, time from onset to intravenous thrombolysis > 4.5h, and high serum PPAR-γ and Leptin levels were all independent risk factors for poor prognosis of urokinase intravenous thrombolysis in patients with ACI (P < 0.05). ROC curve research results showed that: The AUC for predicting adverse prognosis in patients with ACI based on the combination of atrial fibrillation, time from onset to intravenous thrombolysis (> 4.5h), NIHSS score before thrombolysis (> 10 points), high serum PPAR-γ level and Leptin level was 0.666 (95%CI: 0.540-0.792), 0.614 (95%CI: 0.482-0.746), respectively. 0.781 (95%CI: 0.676-0.887), 0.694(95%CI: 0.572-0.816), 0.712 (95%CI: 0.592-0.832); The specificity were 62.53%, 60.04%, 78.15%, 75.08% and 46.92%, respectively. The specificity was 67.51%, 61.73%, respectively. 67.59%, 60.03% and 87.55%, The ROC AUC of the predictive model for predicting adverse outcomes in patients with ACI was 0.879 (95%) CI: 0.802-0.956), with a sensitivity of 84.43%, specificity of 77.56%, and Jordan Index of 0.619.Conclusion There are many risk factors affecting the poor prognosis of patients with ACI after intravenous thrombolysis with urokinase, among which the NIHSS score, serum PPAR-γ level and Leptin level have better prediction efficiency before thrombolysis. The predictive model constructed in this study has high predictive value for poor prognosis of patients with ACI, which is worthy of clinical reference.