Objective To investigate the influencing factors of disease progression and prognosis in patients with large artery atherosclerotic (LAA) cerebral infarction and analyze the value of plasma cyclin-dependent kinase 9 (CDK9) level in the diagnosis and treatment of LAA cerebral infarction.

Methods Patients with acute cerebral infarction admitted to the Department of Neurology of the Affiliated Hospital of Yangzhou University between March 1, 2022, and November 20, 2023, were selected. According to the diagnostic criteria, 98 patients with acute LAA (LAA group) and 33 patients with acute small artery occlusion (SAO) cerebral infarction (SAO group) were selected. Additionally, 40 healthy individuals matched for age and gender from the Health Examination Center were included as control group. Based on whether the condition of LAA cerebral infarction patients progressing, they were divided into progressive cerebral infarction (PCI) group (39 patients) and the non-progressive cerebral infarction (NPCI) group (59 patients). During the 3-month follow-up period, 6 patients from the 98 LAA cerebral infarction patients were lost. According to the modified Rankin Scale (mRS) score at 90 days of follow-up, patients were divided into good prognosis group (mRS score ≤ 2, 59 patients) and poor prognosis group (mRS score >2, 33 patients). Fasting lipid indices total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), glucose (GLU), glycated hemoglobin (HbA1c), and homocysteine (Hcy) were collected on the second day after admission. The National Institutes of Health Stroke Scale (NIHSS) was used to assess the degree of neurological impairment in cerebral infarction patients. Enzyme-linked immunosorbent assay (ELISA) was used to measure plasma CDK9 levels in different groups; factors influencing disease progression in patients with acute LAA cerebral infarction were explored; and receiver operating characteristic curves were plotted to evaluate the predictive value of CDK9 in patients with acute LAA cerebral infarction.

Results Compared with the control group, the LAA group had lower HDL-C level and higher CDK9 level (P < 0.05). The LAA group had a higher proportion of diabetes history, larger infarction volume, higher NIHSS score at admission, and higher CDK9 level compared with the SAO group (P < 0.05). Binary Logistic regression analysis showed that diabetes history and plasma CDK9 levels were influencing factors for LAA cerebral infarction. There were statistically significant differences in the proportion of diabetes history, HbA1c, random GLU, and CDK9 levels between the NPCI and PCI groups (P < 0.05).Diabetes history and plasma CDK9 levels were influencing factors for disease progression in patients with acute LAA cerebral infarction. The area under the ROC curve for CDK9 in predicting acute LAA cerebral infarction was 0.854 5 (95%CI, 0.794 1 to 0.914 8). When the CDK9 level was 602.1 ng/L, the Youden index was maximum (0.604), with a corresponding sensitivity of 0.849 and specificity of 0.755.The NIHSS score, infarction volume, and plasma CDK9 level were higher in the poor prognosis group compared with the good prognosis group (P < 0.01). Correlation analysis showed a positive correlation between mRS scores and CDK9 levels (r=0.485, P < 0.01).

Conclusion Plasma CDK9 levels are significantly elevated, and is an influencing factor. It is positively correlated with disease progression and poor prognosis in acute cerebral infarction and has certain predictive value for the progression of LAA cerebral infarction.