Background and Purpose: Albumin to globulin ratio (A/G) has been established as a representative biomarker for assessing inflammation and nutritional status. However, the prognostic value of A/G has rarely been reported in acute ischemic stroke (AIS) patients with intravenous thrombolysis (IVT). Methods: A total of 311 AIS patients who had undergone IVT and completed 3-month follow-up were retrospectively recruited in this study. Albumin (Alb), globulin (Glb) and A/G on admission, within 24 hours after IVT and on day 7 were recorded. Poor outcome was defined as death or major disability (modified Rankin Scale, 3– 6) at 3 months. Results: Among the 311 cases, 260 patients had admission blood samples, 296 cases had blood samples within 24 hours after IVT and 126 cases had blood samples on day 7. The patients with and without available blood samples were well-balanced. During the first 24 h, we observed A/G to increase significantly compared with baseline whereas at day 7 it was almost back to baseline in patients with a poor outcome. Receiver operating characteristic (ROC) curves analysis showed that A/G had a better performance in discriminating patients at high risk and low risk of a poor outcome than either Alb or Glb alone and carried the highest predictive ability on day 7 (AUC = 0.807). Lower 7-day A/G was independently associated with a poor outcome (per-SD increase, OR = 0.182, 95% CI: 0.074– 0.446). Conclusion: A/G is an important prognostic indicator for AIS outcomes and merits dynamic monitoring.

Background and Purpose: The dynamic systemic inflammation level and stroke-associated infection (SAI) are related to the prognosis of acute ischemic stroke (AIS). We aimed to explore whether the systemic inflammatory response index (SIRI), systemic immune inflammation index (SII), and their dynamic changes possess predictability for SAI and long-term prognosis. Methods: A total of 1804 AIS patients without intravenous thrombolysis in two hospitals were included. We explored the relationship between SIRI, SII, and their dynamic changes and outcomes by constructing clusters. The mediating effects of SAI between prognosis and systemic inflammation were further evaluated. Results: Each SD increase in the concentration of SIRI exhibited a significant correlation with the risk of poor functional outcome, mortality, and functional dependency. Through K-means clustering analysis, patients with dramatically elevated or decreased systemic inflammation levels of SIRI (OR: 2.293, 95% CI: 1.279– 4.109) and SII (OR: 3.165, 95% CI: 1.627– 6.156) within 7 days had a higher risk of functional outcome. Through mediation analysis, SAI mediated the association between systemic inflammation and poor prognosis (SIRI: 33.73%, SII: 16.01%). Conclusion: Dramatically changing dynamics of SIRI and SII were significantly associated with a higher risk of poor prognosis in AIS patients. SAI mediated the association between systemic inflammation and prognosis at 1 year.

Purpose: Myasthenia gravis (MG) is a chronic autoimmune disease caused by neuromuscular junction (NMJ) dysfunction. Our current understanding of MG’s inflammatory component remains poor. The systemic inflammatory response index (SIRI) presents a promising yet unexplored biomarker for assessing MG severity. This study aimed to investigate the potential relationship between SIRI and MG disease severity. Patients and Methods: We conducted a retrospective analysis of clinical data from 171 MG patients admitted between January 2016 and June 2021. Patients with incomplete data, other autoimmune diseases, or comorbidities were excluded. Disease severity was evaluated using the Myasthenia Gravis Foundation of America (MGFA) classification and Myasthenia Gravis Activities of Daily Living (MG-ADL) on admission. The association between SIRI and disease severity was assessed through logistic regression analysis, along with receiver operating characteristic (ROC) curve and decision curve analysis (DCA) comparisons with established inflammation indicators. Results: After exclusion, 143 patients were analyzed in our study. SIRI levels significantly differed between patients with higher and lower disease severity (p < 0.001). Univariate logistic regression showed that SIRI had a significant effect on high disease severity (OR = 1.376, 95% CI 1.138– 1.664, p = 0.001). This association remained significant even after adjusting for age, sex, disease duration, history of MG medication and thymoma (OR = 1.308, 95% CI 1.072– 1.597, p = 0.008). Additionally, a positive correlation between SIRI and MG-ADL was observed (r = 0.232, p = 0.008). Significant interactions were observed between SIRI and immunosuppressor (p interaction = 0.001) and intravenous immunoglobulin (p interaction = 0.005). DCA demonstrated the superior net clinical benefit of SIRI compared to other markers when the threshold probability was around 0.2. Conclusion: Our findings indicate a strong independent association between SIRI and disease severity in MG, suggesting SIRI’s potential as a valuable biomarker for MG with superior clinical benefit to currently utilized markers.

Discrepancies in serum electrolyte levels have been observed between stroke patients and healthy individuals. Previous studies have indicated an association between electrolytes and all‐cause mortality as well as cardiovascular events in stroke patients. However, there still lacks comprehensive analysis on the connection between electrolytes and negative outcomes in hypertensive individuals with early neurological deterioration (END). Totally 1341 patients treated with thrombolysis for acute ischemic stroke at the First Affiliated Hospital of Wenzhou Medical University were included. Outcomes included END, 3‐month, 6‐month, and 1‐year poor prognosis. Logistic regression assessed the correlation and restricted cubic spline analysis examined dose‐response relationships. Subgroup analysis validated the relationship between electrolytes and prognosis in hypertensive patients. A total of 242 patients exhibited a 3‐month poor prognosis. Significant differences were observed in Cl⁻, Ca²⁺, and Mg²⁺ levels between mRS binary classification. Logistic regression identified Cl⁻ as the strongest predictor for 3‐month, 6‐month, and 1‐year mRS score and Ca²⁺ for END. Restricted cubic spline analysis revealed relationships between higher concentrations of Na⁺ and poorer prognosis. In the hypertension subgroup, a higher concentration of Na⁺ indicated worse 6‐month and 1‐year outcomes and a lower concentration of Ca²⁺ was linked to a higher risk of END. The concentration of Na⁺ is related to adverse clinical outcomes, while that of Cl⁻ and Ca²⁺ are associated with END. Among hypertensive patients, elevated levels of Na⁺ and Ca2⁺ concentration are respectively associated with 6‐month poor prognosis and END. Monitoring the electrolytes may promote the early identification of individuals at high risk of poor functional outcomes.

Objective. We aimed to evaluate and compare the association between globulin to albumin ratio (GAR) and globulin to prealbumin ratio (GPR) and 3-month functional prognosis of acute ischemic stroke (AIS) patients receiving intravenous thrombolysis therapy. Methods.234 AIS patients undergoing intravenous thrombolysis were retrospectively enrolled with acute ischemic stroke from February 2016 to October 2019. Blood sample was collected within 24 h after admission. Poor outcome was defined as the modified and a favorable outcome as . Severe stroke was defined as the on admission. Student’s -test, Mann–Whitney test, Chi-square test, logistics’ regression analysis, and receiver operating characteristic (ROC) analysis were performed. Results. Patients with poor functional outcome had higher GAR and GPR levels compared with favorable functional group ( , , respectively). Severe stroke was also associated with these two increasing variables. After adjustment for confounding factors, multivariate logistic regression analysis indicated that GPR was an independent indicator predictor of AIS. Conclusions. The 24 h GPR level can predict the 3-month functional outcome in AIS patients accepting recombinant tissue plasminogen activator (r-tPA) intravenous thrombosis.

The Neutrophil to Albumin Ratio (NAR) stands out as a novel integrative inflammatory biomarker that is associated with the occurrence of stroke-associated infection (SAI). Our objective is to comprehensively investigate the predictive capacity of NAR regarding the incidence of SAI and poor functional outcomes after spontaneous intracerebral hemorrhage (sICH). We retrospectively enrolled 291 patients categorized into tertiles based on their NAR levels. Cox Proportional Hazards regressions, Kaplan-Meier curves with log-rank tests, and restricted cubic splines were utilized to elucidate the associations between NAR and SAI. Logistic regressions were used to investigate the associations between the poor functional outcome and NAR. To determine the role of SAI in the effect of NAR on the risk of poor functional outcome, mediation analyses were performed. The improvements in model discriminations and calibrations by incorporating NAR into ICH score and max-ICH score were comprehensively explored. With each standard deviation increase in NAR after full adjustments, the risks of SAI and poor functional outcome at 3 months rose by 43% and 76%, respectively. Furthermore, incorporating NAR into the ICH score and max-ICH score enhanced both the discrimination and calibration of model performance. Intriguingly, the proportion of the total effect mediated was 9.89% and 10.25% for poor functional outcome at 3 months (p = 0.010) and 1 year (p = 0.024). Elevated NAR is a superior biomarker capable of predicting SAI and poor functional outcome after sICH. The association between NAR and the functional outcome is mildly yet significantly mediated by SAI.