Analysis of immune cells and risk factors related to lower limb deep vein thrombosis in patients with cerebral infarction.

Am J Clin Exp Immunol 2024;13(3):133-139 www.ajcei.us /ISSN:2164-7712/AJCEI0155023 Original Article Analysis of immune cells and risk factors related to lower limb deep vein thrombosis in patients with cerebral infarction Feng-Dan Hu1,2*, Yun Miao2*, Bo Yu2,3*, Xiao-Zhen Deng1, Ran Sun2, Jin Qian1, Hai-Xin Yuan1 Shanghai Fifth Rehabilitation Hospital, Shanghai 201600, China; 2Shanghai First People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 201600, China; 3Sanda University, Shanghai 201209, China. *Equal contributors. 1 Received December 19, 2023; Accepted June 17, 2024; Epub June 25, 2024; Published June 30, 2024 Abstract: To explore the characteristics of hematologic indicators and related risk factors of lower extremity deep vein thrombosis (LDVT) in patients with cerebral infarction. Methods: This study retrospectively analyzed data from 174 patients with cerebral infarction admitted to The Rehabilitation Department of Shanghai Fifth Rehabilitation Hospital and Shanghai First People’s Hospital from June 2022 to June 2023. Based on the results of lower limb venous color Doppler ultrasound examinations, patients were divided into two groups: the LDVT group (35 cases) and the non-LDVT group (139 cases). We compared the clinical data and hematologic indicators (D-dimer value, fibrinogen, white blood cells, platelets, uric acid, creatinine, etc.) of the two groups to identify the risk factors of cerebral infarction complicated with LDVT. Results: Statistical analysis revealed that the D-dimer values of the LDVT group were significantly (P<0.05) higher than those of the non-LDVT group. The uric acid value of the LDVT group was significantly lower than that of the non-LDVT group, with statistical significance (P<0.05). The Brunnstrom staging in the LDVT group was significantly different from that in the non-LDVT group (P<0.05). Meanwhile, binary logistic regression analysis showed that LDVT complicated with cerebral infarction was associated with D-dimer level [OR=1.302, 95% CI (1.077, 1.575)], uric acid level [OR=0.995, 95% CI (0.990, 1.000)], and Brunnstrom staging [OR=3.005, 95% CI (1.312, 6.880)]. Conclusion: D-dimer value, uric acid value, and Brunnstrom stage I to II are closely related to the occurrence of LDVT in patients with cerebral infarction. High D-dimer value, low uric acid value, and Brunnstrom stage I to II are independent risk factors for LDVT in cerebral infarction. Early assessment of D-dimer value, uric acid value, and Brunnstrom stage of cerebral infarction should be considered in clinical practice. Keywords: Cerebral infarction, lower limbs, deep vein thrombosis, blood indicators Introduction Cerebral infarction can lead to functional impairments, such as hemiplegia, aphasia, dysphagia, and decreased level of consciousness [1]. Annually, 2 million new patients with stroke are diagnosed in China [2], and nearly half of the patients are at risk of LDVT [3]. LDVT poses a high risk of pulmonary embolism, and previous studies have shown that 35.1% of patients with LDVT experience pulmonary embolism [4]. In severe cases, it can threaten the patient’s life [5]. Therefore, early detection and treatment of LDVT is critical. Recent studies have found that deep vein thrombosis is related to immune response. Through immune mechanisms, immune dysfunction can increase the risk of deep vein thrombosis. As the main immune cells, white blood cells participate in the initiation and spread of thrombosis [6]. There is a lack of risk assessment for cerebral infarction complicated with LDVT in clinical practice. Therefore, this study collected relevant hematologic indicators and clinical data from patients with cerebral infarction to identify the risk factors of cerebral infarction complicated with LDVT. https://doi.org/10.62347/DRPN1199 A study on DVT in stroke patients Materials and methods Case selection, data collection, and grouping Inclusion criteria were as follows: 1) those who meet the diagnostic criteria for cerebrovascular diseases revised by the 4th National Conference on Cerebrovascular Diseases [7], and were confirmed to have cerebral infarction and lower limb dysfunction through cranial imaging examination; 2) 30 years old ≤ Age ≤90 years old; 3) 1 week ≤ disease course ≤3 months; 4) within 3 days of admission, the patient underwent lower limb venous ultrasound, routine biochemistry and blood test, and complete coagulation tests; 5) stable vital signs; and 6) signed informed consent form was provided. Exclusion criteria were as follows: 1) Hemorrhagic cerebrovascular disease; 2) Incomplete clinical data; 3) Patients with serious illnesses, those taking special medications such as hormones, and those with severe organ dysfunction; 4) Severe cerebral infarction complicated with intracranial hypertension or severe consciousness disorders; and 5) Hematologic diseases. From June 2022 to June 2023, 174 patients with recovery after stroke who were initially hospitalized in the Rehabilitation Department of Shanghai Fifth Rehabilitation Hospital and Shanghai First People’s Hospital and met the above criteria were included. They were divided into the LDVT group and the non-LDVT group based on the presence or absence of LDVT. This study was approved by the Ethics Committee of Shanghai First People’s Hospital ([2023] 094). Within 3 days of admission, we conducted lower limb deep vein color Doppler ultrasound examination on 174 patients with cerebral infarction to determine the presence of LDVT. Diagnostic criteria were as follows [8]: 1) solid echo found in the venous lumen of the lower limb; 2) partial compression or inability to compress the venous lumen after probe pressure; 3) lack of color blood flow and pulse Doppler ultrasound blood flow at the site of thrombosis; 4) the patient’s blood flow spectrum did not change with breathing; 5) the diameter of collateral veins widened. In total, 174 patients with cerebral infarction were divided into the 134 LDVT (35 cases) and non-LDVT groups (139 cases) based on the results of color Doppler ultrasound of deep veins of lower limbs. We also measured the effect of antiplatelet therapy. Data collection and research methods According to the results of lower limb ultrasound, patients were divided into two groups, namely the LDVT and non-LDVT groups. Clinical data of the two groups of patients were collected, including gender, course of disease, age, history of smoking, hypertension, drinking, hyperlipidemia, and diabetes, consciousness disorder, dysphagia, speech disorder, hemiplegia, muscle tone, antiplatelet therapy, etc. In addition, data on indicators, such as hemoglobin, albumin, fibrinogen, white blood cells, fasting blood glucose, neutrophil percentage, globulin, platelet count, creatinine, calcium, sodium, uric acid, D-dimer, neutrophil count, eosinophil count, lymphocyte count, monocyte count, etc., were detected in the venous blood in the morning the next day of admi (...truncated)