Value of plasma neutrophil extracellular traps on illness condition and prognosis in patients with acute cerebral infarction

To analyze correlations of the main components of neutrophil extracellular traps (NETs)[citrulline histone 3 (CitH3) and double-stranded DNA (dsDNA)] with the ill severity in patients with acute cerebral infarction (ACI)and its predictive value in prognosis.

A total of 120 patients with ACI were collected as study objects, and were divided into mild group[65 cases, the National Institutes of Health Stroke Scale (NIHSS) score of 0 to 4] and severe group (55 cases, the NIHSS score of 4 to 15) according to severity of illness. Before and after treatment, plasma CitH3, dsDNA, N-terminal B-type natriuretic peptide (NT-proBNP), platelet (PLT), prothrombin time (PT), international standardized ratio (INR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-high density lipoprotein cholesterol ratio(MHR) and modified Edinburgh-Scandinavian Stroke Scale (MESSS) score were detected in two groups, and the correlations of above clinical indexes with the NIHSS scores were analyzed. According to the modified Rankin Scale score at the last follow-up, the patients were divided into good prognosis group (98 cases) and poor prognosis group (22 cases). The difference of clinical indicators between the two groups was compared, and the correlations of clinical indicators with poor prognosis of ACI patients were analyzed. Receiver operating characteristic (ROC) curve was drawn to analyze the diagnostic performance of plasma CitH3 combined with dsDNA for the prognosis of ACI patients.

The levels of CitH3, dsDNA, NT-proBNP, MHR and MESSS before and after the treatment in the severe group were all higher than those in the mild group (P<0.05), but the levels of PLT, PT, INR, NLR and PLR showed no significant differences between two groups (P>0.05). The positive correlation of the indexes of CitH3, dsDNA and NT-proBNP with the NIHSS scores were found (r=0.814, 0.775, 0.725; P<0.05). After 1-year follow-up, the levels of plasma CitH3, dsDNA and NT-proBNP in the poor prognosis group were higher than those in the good prognosis group(P<0.05). The increased CitH3 and dsDNA were the risk factors to the short-term poor prognosis in patients with ACI (OR=2.913, P=0.029; OR=2.887, P=0.036). The area under the curve of plasma CitH3 combined with plasma dsDNA in predicting poor prognosis of ACI patients at 1 year follow-up was 0.823, sensitivity was 84.5%, and specificity was 89.5%.

The combined detection of main components of CitH3 and dsDNA of plasma NETs can effectively evaluate the ill severity of patients with ACI, and has good predictive value of the short-term prognosis.