Demographics and characteristics of participants
A total of 236 patients with acute ischemic stroke were included in our study. Baseline characteristics were shown in Table 1. The median age of all patients was 69 (58, 75) years old. 158 (66.95%) patients were male and the ratio of male to female was about 7:3. 173 (73.31%) patients had hypertension. 55 (23.31%) patients had diabetes. NIHSS score was 1.0 (1.0, 6.0). MRS score was 1.0 (0, 2.0).
Table 1
The characteristics of all included patients
Characteristics | Patients (N = 236) |
Demographics and medical history | |
Age in years, median (IQR) | 69 (58, 75) |
Male, n (%) | 158 (66.95) |
Diabetes, n (%) | 116 (27.20) |
Hypertension, n (%) | 173 (73.31) |
Clinical features | |
NK cell (%), median (IQR) | 14.30 (9.53, 22.85) |
CFB (mg/dL), median (IQR) | 35.90(30.45, 40.88) |
C3 (g/L), median (IQR) | 0.87 (0.75, 0.97) |
CD4 + T cell (%), median (IQR) | 41.89 (35.80, 49.19) |
T cell (%), median (IQR) | 70.45 (62.21, 75.63) |
CD4+/CD8+, median (IQR) | 1.76(1.29, 2.44) |
C4 (g/L), median (IQR) | 0.21 (0.18, 0.25) |
CD8 + T cell (%), median (IQR) | 24.30 (19.16, 29.55) |
B cell(%), median (IQR) | 12.22(8.57, 16.64) |
Outcomes | |
NIHSS, median (IQR) | 1.5 (0.0, 6.0) |
MRS, median (IQR) | 1.0(0, 2.0) |
Immunocytes, complements and stroke severity
Baseline characteristics
All the patients were categorized as mild (NIHSS score 0–4), moderate (NIHSS score 5–10), and severe group (NIHSS score ≥ 11)according to NHISS score at admission[15]. The characteristics of the patients are presented in Table 2. Gender (p = 0.176), prevalence of hypertension (p = 0.510) and diabetes (p = 0. 831) showed no significant difference in three groups. Age showed significant difference between severe group and other two groups. The patients in severe group are older than mild group (p = 0. 004) and moderate group (p = 0. 026). Age is not significantly different between mild group and moderate group (p = 0. 539).
Table 2
Comparison of demographic, clinical characteristics, immunocytes and complements among patients with different level of NHISS score
NIHSS | 0–4 | 5–10 | ≥ 11 | P value | Post-hoc# |
Demographics and medical history |
Number | 161 | 57 | 18 | - | - |
Gender (male%) | 70.19 | 63.16 | 50 | 0.176 | 1 = 2 = 3 |
Age (year) | 68 (57, 75) | 70 (55, 75) | 76 (69, 84) | 0.004** | 1 = 2 < 3 |
Hypertenstion(%) | 71.43 | 75.44 | 83.33 | 0.510 | 1 = 2 = 3 |
Diabetes(%) | 23.6 | 21.05 | 27.78 | 0.831 | 1 = 2 = 3 |
Immunocytes and complements |
NK cell (%) | 13.69 (9.35, 21.32) | 14.25 (9.35, 21.32) | 24.65 (14.00, 31.71) | 0.015* | 1 = 2 < 3 |
CFB (mg/dL) | 34.50 (29.75, 40.20) | 37.50 (32.15, 44.45) | 39.30 (33.35, 47.80) | 0.007** | 1 < 2 = 3 |
C3 (g/L) | 0.85 (0.75 0.95) | 0.89 (0.75, 1.03) | 0.90 (0.85, 1.04) | 0.035* | 1 < 2 = 3 |
CD4 + T cell (%) | 42.38 (36.22, 49.78) | 44.13 (36.55, 49.23) | 36.13 (31.93, 40.04) | 0.009** | 1 = 2 > 3 |
T cell (%) | 71.12 (63.55, 76.52) | 71.33 (62.87, 75.02) | 57.78 (50.85, 63.87) | 0.001** | 1 = 2 > 3 |
CD4+/CD8+ | 1.72 (1.31 2.50) | 1.73 (1.26 2.40) | 1.98 (1.44, 2.61) | 0.556 | 1 = 2 = 3 |
C4 (g/L) | 0.21 (0.17, 0.24) | 0.23 (0.18, 0.27) | 0.23 (0.20, 0.28) | 0.037* | 1 = 2 = 3 |
CD8 + T cell (%) | 24.52 (20.28, 29.97) | 23.88 (19.35, 29.13) | 17.85 (11.56, 26.18) | 0.031* | 1 = 2 = 3 |
B cell (%) | 11.60 (8.15, 15.57) | 13.72 (9.75, 17.27) | 14.89 (8.54, 18.39) | 0.100 | 1 = 2 = 3 |
*P < 0.05 |
**P < 0.01 |
# In the column of post-hoc analysis, 1 = mild group (NHISS 0–4), 2 = moderate group (NHISS 5–10), 3 = severe group (NHISS ≥ 11) |
Comparison of immunocytes and complements
Table 2 shows comparison of each immune factors in three groups. Statistical analysis indicated that NK cell(p = 0. 015), CFB (p = 0. 007), C3 (p = 0. 035) were significantly elevated in groups with higher NHISS score. CD4 + T cell (p = 0. 009), T cell (p = 0. 001) are decreased in groups with higher NHISS score. There was no significant difference on C4, CD8 + T cell and B cell. Results of post-hoc analysis was list in Table 2.
Association of immunocytes, complements and stroke severity
In multivariate logistic regression (Table 3), CFB, C3 were independently associated with severity of stroke adjusting for age, gender, hypertension, diabetes. CD4 + T cell, NK cell, T cell were independently associated with severe ischemic stroke.
Table 3
Association of immunocytes, complements and stroke severity (multivariate logistic regression)
| NHISS | OR | P value |
CFB | 0–4 | 1 (reference)# | - |
| 5–10 | 1.057 (1.017–1.097) | 0.000** |
| ≥ 11 | 1.090 (1.026–1.157) | 0.005** |
C3 | 0–4 | 1 (reference) | - |
| 5–10 | 6.802 (1.103–41.951) | 0.039* |
| ≥ 11 | 17.388 (1.072-282.064) | 0.005** |
NK cell | 0–4 | 1 (reference) | - |
| 5–10 | 0.999 (0.968–1.030) | 0.948 |
| ≥ 11 | 1.053 (1.007–1.101) | 0.023* |
CD4 + T cell | 0–4 | 1(reference) | - |
| 5–10 | 1.001 (0.968–1.035) | 0.974 |
| ≥ 11 | 0.920 (0.863–0.979) | 0.009** |
T cell | 0–4 | 1(reference) | - |
| 5–10 | 0.989 (0.959–1.019) | 0.466 |
| ≥ 11 | 0.909 (0.865–0.955) | 0.000** |
#Mild group as reference in multivariate logistic regression |
Immunocytes, complements and short-term prognosis
Baseline characteristics
All the patients were categorized as mild (mRS 0–2) and severe group (mRS > 2) according to mRS score at 3 months after stroke onset. The characteristics of the patients are presented in Table 4. Gender (p = 0.086), prevalence of hypertension (p = 0.573) and diabetes (p = 0. 993) showed no significant difference in three groups. The patients in severe group are significantly older than mild group (p = 0. 003).
Table 4
Comparison of demographic, clinical characteristics, immunocytes and complements among patients with different level of mRS score
MRS | 0–2 | > 2 | P value |
Demographics and medical history |
Number | 193 | 43 | - |
Gender (male%) | 69.43 | 55.81 | 0.086 |
Age | 68 (56, 75) | 73 (66, 79) | 0.003** |
Hypertenstion(%) | 72.54 | 76.74 | 0.573 |
Diabetes | 23.32 | 23.26 | 0.993 |
Immunocytes and complements |
NK cell (%) | 13.69 (9.21, 22.20) | 17.22 (12.78, 25.50) | 0.049* |
CFB (mg/dL) | 35.50 (30.30, 40.60) | 37.80 (33.50, 45.30) | 0.035* |
C3 (g/L) | 0.86 (0.75, 0.96) | 0.88 (0.79, 1.06) | 0.091 |
CD4 + T cell (%) | 42.81 (36.19, 49.60) | 38.68 (33.96, 47.44) | 0.128 |
T cell (%) | 71.25 (62.93, 76.10) | 66.79 (58.51, 74.78) | 0.050 |
CD4+/CD8+ | 1.75 (1.33, 2.50) | 1.81 (1.21, 2.35) | 0.875 |
C4 (g/L) | 0.21 (0.18, 0.25) | 0.23 (0.19, 0.28) | 0.028* |
CD8 + T cell (%) | 24.40 (19.29, 29.59) | 23.53 (17.65, 29.35) | 0.799 |
B cell (%) | 11.96 (8.46, 15.99) | 13.63 (8.91, 17.15) | 0.495 |
*P < 0.05 |
**P < 0.01 |
Comparison of immunocytes and complements
Table 4 shows comparison of each immune factors in two groups according to mRS score. NK cell (p = 0.049), CFB (p = 0.035), C4 (p = 0.028) are were significantly elevated in groups with higher mRS score.
Association of immunocytes, complements and short-term prognosis
In binary analyses, CFB (p = 0.009, OR: 1.056, 95%CI: 1.014–1.099), C4 (p = 0.011, OR: 134.444, 95%CI: 3.115-5803.504) were independently associated with prognosis at 3 months after acute ischemic stroke adjusting for age, gender, hypertension, diabetes(Table 5). NK cell was not independently associated with short-term prognosis.
Table 5
Association of immunocytes, complements and prognosis at 3 months (binary logistic regression)
| OR | P value |
CFB | 1.056 (1.014–1.099) | 0.009** |
C4 | 134.444 (3.115-5803.504) | 0.011* |
NK cell | 1.007 (0.975–1.040) | 0.687 |
*P < 0.05 |
**P < 0.01 |