Admission markers predict lacunar and non-lacunar stroke in young patients

Abstract

Stroke in young adults is an important cause of lifelong morbidity. The aim of this study was to explore some possible admission indicator of subsequent lacunar or non-lacunar strokes. We enrolled 626 patients with the first young cerebral strokes and divided them into lacunar and non-lacunar stroke based on clinical presentation and neuroradiological findings; and the analyses were adjusted for the effects of potential confounders. Hypertension, hyperlipidemia, atrial fibrillation, cerebral vascular moyamoya malformation were significantly more frequent in non-lacunar patients than lacunar patients (respectively P = 0.005, 0.048, 0.000, 0.015, 0.030). Serum BUN, Triglyceride, Cholesterol, HDL, UA, White cell count, Fibrinogen, INR and bilirubin (including Total bilirubin, Direct bilirubin, Indirect bilirubin) levels on admission were higher in non-lacunar strokes than in lacunar strokes. Serum white blood cell count (Odds Ratio 1.097; 95% Confidence Interval 1.006–1.195, P = 0.035), lower high-density lipoprotein levels (defined as HDL < 0.9 mmol/L)(Odds Ratio 1.884; 95% Confidence Interval 1.035–3.285, P = 0.038) and serum total bilirubin (Odds Ratio 1.054; 95% Confidence Interval 1.019–1.091, P = 0.003) were associated with increased risk for non-lacunar stroke, whereas lacunar stroke was related to age at onset (Odds Ratio 0.929; 95% Confidence Interval 0.888–0.972, P = 0.001) and SUA (Odds Ratio 0.997; 95% Confidence Interval 0.995–0.999, P = 0.015). The excess risks were blood WBC, lower HDL and total bilirubin levels for non-lacunar strokes, and serum UA and age at onset for lacunar strokes in young Chinese patients.

Introduction

Stroke in young adults is an important cause of lifelong morbidity, thus it is important to focus on the prognosis of young cerebral infarction patients. In arterial thrombosis at young age, traditional risk factors such as gender, smoking, diabetes mellitus, obesity and hypercholesterolemia do not fully explain the cerebrovascular risk [1], [2], [3], [4].

The three most common etiology of cerebral infarction are large-vessel atherosclerosis, small vessel disease and cardiac embolism [5], [6]. Histopathologic study disclosed that small vessel disease causes subcortical infarctions < 1.5 cm in diameter (lacunar stroke) [7]. None-lacunar infarctions comprising subcortical infarctions and brainstem infarctions ≥ 1.5 cm with or without involvement of the cortex and pure cortical infarctions tend to be associated with large-vessel atherosclerosis and cardiac embolism [8]. These have included observational studies comparing the risk factor profiles of patients with lacunar versus non-lacunar infarction, since differences might suggest distinct arterial pathologies.

Clinically, we found it is very subjective to distinguish clearly lacunar infarction or non-lacunar cerebral infarction in young patients only through clinical symptoms and signs in contrast to laboratory and radiological indicators. Brain CT imaging studies are often unable to identify existing lesions when they are performed on young patients within the early onset of disease (most of them within 24 hours). Therefore, we often miss the best time to take appropriate treatment for young patients.

In the study, we conducted a retrospective study on a series of young patients with cerebral infarction and compared a group of definite lacunar infarcts with another group of nonlacunar infarcts by analysing the distribution of vascular risk factors and several clinical/instrumental variables. The aim of this study was to explore some possible admission indicators related to subsequent lacunar or non-lacunar strokes.