Value of acetylcholinesterase and neutrophil-to-lymphocyte ratio in predicting prognosis of stroke-associated pneumonia

  Objective  To explore the predictive value of acetylcholinesterase (AChE), neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) on stroke associated pneumonia (SAP) in patients with acute cerebral infarction (ACI).

  Methods  A total of 202 ACI patients were retrospectively enrolled as study objects, including 105 patients with SAP (SAP group) and 97 patients without SAP (control group). Venous blood was collected within 24 h of admission to detect the levels of AChE, NLR and CRP. The National Institutes of Health Stroke Scale (NIHSS) score was evaluated. Univariate and multivariate analyses were used to investigate the risk factors of SAP in ACI patients; Receiver Operating Characteristic (ROC) curve was used to analyze the predictive value of AChE and NLR for SAP; the severity and prognosis of patients with different AChE and NLR levels were compared.

  Results  Age, proportion of atrial fibrillation, neutrophil count, NLR, AChE, NIHSS score, and mortality rate in the SAP group were higher than those in the control group, while lymphocyte count was lower and hospital stay was longer than those in the control group (P < 0.05 or P < 0.01). Logistic regression results showed that AChEhazard ratio (HR)= 0.99, 95% confidence interval (CI), 0.98 to 1.00)and NLRHR=3.10, 95%CI, 1.89 to 5.10 were independent influencing factors of SAP. ROC curve analysis showed that AChE (area under the curve (AUC)=0.92, cut-off value of 5 994.00 U/L, sensitivity of 88.60%, specificity of 87.60%) and NLR (AUC=0.93, cut-off value of 4.43, sensitivity of 82.90%, specificity of 91.80%) were of high value in predicting risk of SAP, and the predictive value of AChE combined with NLR was higher (AUC=0.98). NIHSS score and mortality rate in the low AChE group were higher than those in the high AChE group, and hospital stay was longer than that in the high AChE group, the differences were statistically significant (P < 0.05). The NIHSS score of the high NLR group was higher than that of the low NLR group, and the length of hospital stay was longer than that of the low NLR group (P < 0.05).

  Conclusion  Serum AChE and NLR are closely related to the occurrence of SAP in ACI patients, and their combination has important clinical value for predicting the risk of SAP. In addition, AChE and NLR levels can affect severity and outcomes of ACI.