Clinical value of APN combined with Lp-PLA2 in predicting functional outcome in patients with cerebral infarction underwent rt-PA intravenous thrombolysis.

objectiveTo analyze the clinical value of Adiponectin (APN) combined with lipoprotein phospholipase A2 (Lp-PLA2) in predicting the prognosis of patients with cerebral infarction undergoing intravenous thrombolysis with recombinant tissue- plasmin activator (rt-PA).

methodsTotal 100 patients admitted to our hospital with cerebral infarction underwent intravenous thrombolysis with rt-PA during June 2022 to June 2023 were chosen as the cerebral infarction group. The healthy control group were composed of 100 healthy people during the same period. The levels of APN and Lp-PLA2 was examined use enzyme-linked immunosorbent assay (ELISA). Patients with cerebral infarction were divided into two groups based on different functional outcomes after 3 months of treatment using the modified Rankin Scale (mRS) score: 55 patients in the good outcome group (mRS score 0–2, patients independently complete daily activities without assistance from others) and 45 patients in the poor outcome group (mRS score 3–6). Multivariate logistic regression analysis was adopted to investigate the influencing factors. Pearson correlation analysis was performed to analyze the correlation. The predictive value of APN and Lp-PLA2 was assessed using receiver operating characteristic (ROC) curves.

resultsPatients in the cerebral infarction group had much lower serum APN levels and higher Lp-PLA2 levels than those in the control group (P < 0.001). Patients were categorized into large artery atherosclerosis (LAA), cardioembolic embolism (CE), and small vessel disease (SVD) according to the TOAST classification. Lp-PLA2 levels were significantly higher in the LAA and SVD groups compared to the CE group (P < 0.05), while APN levels were significantly lower in these groups (P < 0.05). At three months post-intravenous thrombolysis with rt-PA, patients in the poor outcome group exhibited significantly higher values for age, pre-treatment NIHSS score, pre-stroke mRS score, maximum infarct diameter, serum Lp-PLA2 level, and total complication rate compared to those in the favorable outcome group. Serum APN levels were significantly lower in the poor outcome group. All differences were statistically significant (P < 0.01). Age, NIHSS score before thrombolysis, serum Lp-PLA2 and total complication rate were independent risk factors affecting adverse outcomes after rt-PA intravenous thrombolysis in patients with cerebral infarction (P < 0.05), and APN level was an independent protective factor (P < 0.05). Pearson correlation analysis showed a significant negative correlation between APN and mRS scores (r=-0.677, P < 0.001); Lp-PLA2 was significantly positively correlated with mRS score (r = 0.2334, P = 0.001). The ROC curve showed that the area under the curve (AUC) of serum APN and Lp-PLA2 for predicting functional outcomes after thrombolysis in cerebral infarction was 0.886 and 0.785, respectively. The AUC of serum APN + Lp-PLA2 was 0.913, with a sensitivity of 88.89% and a specificity of 81.82% (P < 0.05).

conclusionAbnormally expressed serum APN and Lp-PLA2 in patients with cerebral infarction were correlated with mRS scores. APN and Lp-PLA2 had a certain clinical value in predicting functional outcome after rt-PA intravenous thrombolytic therapy in patients with cerebral infarction.