Wen-Jun Tu1, Han-Cheng Qiu1, Yiqun Zhang1, Jian-Lei Cao1, Hong Wang1, Ji-Zong Zhao2, Qiang Liu2, Xianwei Zeng2. 1. From the Institute of Radiation Medicine (W.-J.T., H.W., Q.L.), China Academy of Medical Science & Peking Union Medical College, Tianjin; Department of Neurosurgery (W.-J.T., H.-C.Q., J.-Z.Z.), Beijing Tiantan Hospital of Capital Medical University, Beijing; Department of Neurosurgery (W.-J.T., X.Z.), Qilu Hospital of Shandong University, Jinan, Shandong Province; Department of Vascular Neurosurgery (H.-C.Q., Y.Z.), New Era Stroke Care and Research Institute, the General Hospital of the PLA Rocket Force, Beijing; and Department of Cardiology (J.l.-C.), Zhongnan Hospital of Wuhan University, Wuhan, China. 2. From the Institute of Radiation Medicine (W.-J.T., H.W., Q.L.), China Academy of Medical Science & Peking Union Medical College, Tianjin; Department of Neurosurgery (W.-J.T., H.-C.Q., J.-Z.Z.), Beijing Tiantan Hospital of Capital Medical University, Beijing; Department of Neurosurgery (W.-J.T., X.Z.), Qilu Hospital of Shandong University, Jinan, Shandong Province; Department of Vascular Neurosurgery (H.-C.Q., Y.Z.), New Era Stroke Care and Research Institute, the General Hospital of the PLA Rocket Force, Beijing; and Department of Cardiology (J.l.-C.), Zhongnan Hospital of Wuhan University, Wuhan, China. zhaojztj205@126.com wfzwxin@126.com liuqiang_cams@163.com.
Abstract
OBJECTIVE: To explore the association between serum retinoic acid (RA) level in patients with acute ischemic stroke (AIS) and mortality risk in the 6 months after admission. METHODS: From January 2015 through December 2016, patients admitted to 3 stroke centers in China for first-ever AIS were screened. The primary endpoint was all-cause mortality or cardiovascular disease (CVD) mortality in the 6 months after admission. The significance of serum RA level, NIH Stroke Scale score, and established risk factors in predicting mortality were determined. The integrated discrimination improvement (IDI) and net reclassification improvement (NRI) statistics were applied in statistical analysis. RESULTS: Of the 1,530 patients enrolled, 325 died within 6 months of admission, with an all-cause mortality of 21.2% and CVD-related mortality of 13.1%. In multivariable analysis, RA levels were expressed as quartiles with the clinical variables. The results of the second to fourth quartiles (Q2-Q4) were compared with the first quartile (Q1); RA levels showed prognostic significance, with decreased all-cause and CVD mortality of 55% and 63%, respectively. After RA was added to the existing risk factors, all-cause mortality could be better reclassified, in association with only the NRI statistic (p = 0.005); CVD mortality could be better reclassified with significance, in association with both the IDI and NRI statistics (p < 0.01). CONCLUSIONS: Low circulating levels of RA were associated with increased risk of all-cause and CVD mortality in a cohort of patients with first-incidence AIS, indicating that RA level could be a predictor independent of established conventional risk factors.
OBJECTIVE: To explore the association between serum retinoic acid (RA) level in patients with acute ischemic stroke (AIS) and mortality risk in the 6 months after admission. METHODS: From January 2015 through December 2016, patients admitted to 3 stroke centers in China for first-ever AIS were screened. The primary endpoint was all-cause mortality or cardiovascular disease (CVD) mortality in the 6 months after admission. The significance of serum RA level, NIH Stroke Scale score, and established risk factors in predicting mortality were determined. The integrated discrimination improvement (IDI) and net reclassification improvement (NRI) statistics were applied in statistical analysis. RESULTS: Of the 1,530 patients enrolled, 325 died within 6 months of admission, with an all-cause mortality of 21.2% and CVD-related mortality of 13.1%. In multivariable analysis, RA levels were expressed as quartiles with the clinical variables. The results of the second to fourth quartiles (Q2-Q4) were compared with the first quartile (Q1); RA levels showed prognostic significance, with decreased all-cause and CVDmortality of 55% and 63%, respectively. After RA was added to the existing risk factors, all-cause mortality could be better reclassified, in association with only the NRI statistic (p = 0.005); CVDmortality could be better reclassified with significance, in association with both the IDI and NRI statistics (p < 0.01). CONCLUSIONS: Low circulating levels of RA were associated with increased risk of all-cause and CVDmortality in a cohort of patients with first-incidence AIS, indicating that RA level could be a predictor independent of established conventional risk factors.
Authors: H Nishi; N Hosomi; K Ohta; S Aoki; M Nakamori; T Nezu; H Shigeishi; T Shintani; T Obayashi; K Ishikawa; N Kinoshita; Y Shiga; M Sugiyama; H Ohge; H Maruyama; H Kawaguchi; H Kurihara Journal: Clin Exp Immunol Date: 2020-03-24 Impact factor: 4.330