Value of the atherogenic index of plasma and programmed cell death 4 in predicting neurological deficits and prognosis in acute ischemic stroke

doi:10.3877/cma.j.issn.1673-9248.2026.04.006

Abstract

Abstract:

Objective

To investigate the value of atherogenic index of plasma (AIP) and programmed cell death 4 (PDCD4) in predicting neurological deficits and prognosis in patients with acute ischemic stroke (AIS).

Methods

This study retrospectively analyzed general data and laboratory parameters from 136 AIS patients admitted to the Department of Neurology at Yan'an People's Hospital from February 2021 to September 2024. Based on the National Institutes of Health stroke scale (NIHSS) score, the AIS patients were divided into mild group (1 to 6 points, 47 cases), moderate group (7 to 15 points, 59 cases), and severe group (＞15 points, 30 cases). Kruskal-Wallis H test was used to compare AIP and PDCD4 levels among the three groups. Spearman's rank correlation coefficient analysis was employed to examine the relationship between AIP, PDCD4, and NIHSS scores. According to the modified Rankin scale (mRS) score at 3 months post-discharge, the AIS patients were categorized into the favorable prognosis group (＜3 points, 81 cases) and the unfavorable prognosis group (≥3 points, 55 cases). Independent sample t-test, Mann-Whitney U test, and Chi-square test were used to compare demographic and laboratory parameters between the two groups. Logistic regression was performed to identify independent risk factors for poor prognosis. The predictive value of AIP and PDCD4 was evaluated using receiver operating characteristic (ROC) curve analysis, and the DeLong test was used to compare areas under the curve (AUC).

Results

AIP of patients in the mild, moderate, and severe groups were 2.06 (1.88, 2.20), 2.20 (2.09, 2.35) and 2.45 (2.37, 2.53), PDCD4 levels were 1.43 (1.18, 1.82), 3.26 (2.35, 3.98) and 4.27 (3.27, 5.05) ng/mL, respectively, with significant differences among groups (H=51.118, 62.184, both P＜0.001). The Spearman correlation analysis results showed that the NIHSS scores were positively correlated with AIP (r=0.545, P＜0.001) and PDCD4 (r=0.646, P＜0.001). The high-density lipoprotein cholesterol [(1.12±0.16) mmol/L vs (1.05±0.14) mmol/L, t=2.721, P=0.007], AIP (2.15±0.24 vs 2.32±0.22, t=4.076, P＜0.001), PDCD4 [1.72 (1.26, 3.07) ng/mL vs 3.88 (2.87, 4.84) ng/mL, Z=-6.844, P＜0.001], and high-sensitivity C-reactive protein (hs-CRP) [4.22 (1.40, 9.91) vs 11.91 (4.15, 44.54) mg/L, Z=-4.753, P＜0.001] in the favorable prognosis group and the poor prognosis group were statistically significant. Binary Logistic regression analysis showed that elevated AIP, hs-CRP, and PDCD4 were independent risk factors for unfavorable prognosis (all P＜0.05). The DeLong test showed that the AUC of PDCD4 alone or combined with AIP in predicting the prognosis of AIS were significantly better than that of AIP alone ( AUC: 0.846, 0.849 vs 0.697; Z=-3.351, -3.422, both P＜0.001). However, no statistically significant difference was found between the AUC of the combination and that of PDCD4 alone (Z=-0.197, P=0.844).

Conclusion

AIP and PDCD4 are correlated with the severity of neurological deficits in AIS patients. PDCD4 alone or combined with AIP has a good predictive performance for the prognosis of AIS patients, with comparable diagnostic accuracy between the two approaches.

Key words: Acute ischemic stroke, Programmed cell death 4, Neurological deficit, Prognosis

Zhixia Kang, Yuxia Ban, Ruyu Bai, Meimei Hao, Zhengzheng Li, Qinqin Su. Value of the atherogenic index of plasma and programmed cell death 4 in predicting neurological deficits and prognosis in acute ischemic stroke[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2026, 20(04): 389-395.

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Figures/Tables 8

项目	轻度组（n=47）	中度组（n=59）	重度组（n=30）	统计值	P值
性别[例（%）]				χ²=0.055	0.973
男	26（55.32）	33（55.93）	16（53.33）
女	21（44.68）	26（44.07）	14（46.67）
年龄（岁， $x ¯$ ±s）	65.53±7.53	65.20±7.98	65.67±7.54	F=0.001	0.999
BMI（kg/m²， $x ¯$ ±s）	23.58±2.94	24.23±2.76	23.89±2.91	F=0.014	0.986
既往病史[例（%）]
高血压	26（55.32）	32（54.24）	17（56.67）	χ²=0.048	0.976
糖尿病	17（36.17）	21（35.59）	10（33.33）	χ²=0.069	0.966
冠心病	9（19.15）	12（20.34）	6（20.00）	χ²=0.024	0.988
心房颤动	8（17.02）	11（18.64）	6（20.00）	χ²=0.113	0.945
吸烟史[例（%）]	10（21.28）	15（25.42）	7（23.33）	χ²=0.251	0.882
饮酒史[例（%）]	10（21.28）	14（23.73）	7（23.33）	χ²=0.096	0.953

项目	轻度组（n=47）	中度组（n=59）	重度组（n=30）	统计值	P值
性别[例（%）]				χ²=0.055	0.973
男	26（55.32）	33（55.93）	16（53.33）
女	21（44.68）	26（44.07）	14（46.67）
年龄（岁， $x ¯$ ±s）	65.53±7.53	65.20±7.98	65.67±7.54	F=0.001	0.999
BMI（kg/m²， $x ¯$ ±s）	23.58±2.94	24.23±2.76	23.89±2.91	F=0.014	0.986
既往病史[例（%）]
高血压	26（55.32）	32（54.24）	17（56.67）	χ²=0.048	0.976
糖尿病	17（36.17）	21（35.59）	10（33.33）	χ²=0.069	0.966
冠心病	9（19.15）	12（20.34）	6（20.00）	χ²=0.024	0.988
心房颤动	8（17.02）	11（18.64）	6（20.00）	χ²=0.113	0.945
吸烟史[例（%）]	10（21.28）	15（25.42）	7（23.33）	χ²=0.251	0.882
饮酒史[例（%）]	10（21.28）	14（23.73）	7（23.33）	χ²=0.096	0.953

组别	例数	AIP	PDCD4（ng/mL）
轻度组	47	2.06（1.88，2.20）	1.43（1.18，1.82）
中度组	59	2.20（2.09，2.35）	3.26（2.35，3.98）
重度组	30	2.45（2.37，2.53）	4.27（3.27，5.05）
H值		51.118	62.184
P值		＜0.001	＜0.001
Z值^a		-3.941	-6.261
P值^a		＜0.001	＜0.001
Z值^b		-6.577	-6.712
P值^b		＜0.001	＜0.001
Z值^c		-4.740	-3.146
P值^c		＜0.001	0.002

项目	预后良好组（n=81）	预后不良组（n=55）	统计值	P值
年龄（岁， $x ¯$ ±s）	65.70±7.64	65.00±7.78	t=0.521	0.603
男性[例（%）]	43（53.09）	32（58.18）	χ²=0.344	0.558
BMI[kg/m²，M（Q₁，Q₃）]	23.67（21.76，25.64）	23.78（21.99，25.90）	Z=-0.328	0.743
既往病史[例（%）]
高血压	45（55.56）	30（54.55）	χ²=0.014	0.907
糖尿病	28（34.57）	20（36.38）	χ²=0.046	0.830
冠心病	15（18.52）	12（21.82）	χ²=0.224	0.636
心房颤动	15（18.52）	10（18.18）	χ²=0.002	0.960
吸烟史[例（%）]	16（19.75）	16（29.09）	χ²=1.587	0.208
饮酒史[例（%）]	20（24.69）	11（20.00）	χ²=0.410	0.522
实验室检查
TC（mmol/L， $x ¯$ ±s）	4.37±0.92	4.42±0.95	t=0.306	0.760
LDL-C（mmol/L， $x ¯$ ±s）	2.94±0.87	2.82±0.90	t=0.770	0.443
HDL-C（mmol/L， $x ¯$ ±s）	1.12±0.16	1.05±0.14	t=2.721	0.007
AIP（ $x ¯$ ±s）	2.15±0.24	2.32±0.22	t=4.076	＜0.001
PLT（×10⁹ /L， $x ¯$ ±s）	164.79±25.44	168.91±30.75	t=0.821	0.414
FIB（g/L， $x ¯$ ±s）	2.71±0.64	2.75±0.71	t=0.345	0.731
hs-CRP[mg/L，M（Q₁，Q₃）]	4.22（1.40，9.91）	11.91（4.15，44.54）	Z=-4.753	＜0.001
PDCD4[ng/mL，M（Q₁，Q₃）]	1.72（1.26，3.07）	3.88（2.87，4.84）	Z=-6.844	＜0.001

项目	预后良好组（n=81）	预后不良组（n=55）	统计值	P值
年龄（岁， $x ¯$ ±s）	65.70±7.64	65.00±7.78	t=0.521	0.603
男性[例（%）]	43（53.09）	32（58.18）	χ²=0.344	0.558
BMI[kg/m²，M（Q₁，Q₃）]	23.67（21.76，25.64）	23.78（21.99，25.90）	Z=-0.328	0.743
既往病史[例（%）]
高血压	45（55.56）	30（54.55）	χ²=0.014	0.907
糖尿病	28（34.57）	20（36.38）	χ²=0.046	0.830
冠心病	15（18.52）	12（21.82）	χ²=0.224	0.636
心房颤动	15（18.52）	10（18.18）	χ²=0.002	0.960
吸烟史[例（%）]	16（19.75）	16（29.09）	χ²=1.587	0.208
饮酒史[例（%）]	20（24.69）	11（20.00）	χ²=0.410	0.522
实验室检查
TC（mmol/L， $x ¯$ ±s）	4.37±0.92	4.42±0.95	t=0.306	0.760
LDL-C（mmol/L， $x ¯$ ±s）	2.94±0.87	2.82±0.90	t=0.770	0.443
HDL-C（mmol/L， $x ¯$ ±s）	1.12±0.16	1.05±0.14	t=2.721	0.007
AIP（ $x ¯$ ±s）	2.15±0.24	2.32±0.22	t=4.076	＜0.001
PLT（×10⁹ /L， $x ¯$ ±s）	164.79±25.44	168.91±30.75	t=0.821	0.414
FIB（g/L， $x ¯$ ±s）	2.71±0.64	2.75±0.71	t=0.345	0.731
hs-CRP[mg/L，M（Q₁，Q₃）]	4.22（1.40，9.91）	11.91（4.15，44.54）	Z=-4.753	＜0.001
PDCD4[ng/mL，M（Q₁，Q₃）]	1.72（1.26，3.07）	3.88（2.87，4.84）	Z=-6.844	＜0.001

变量	β值	SE值	Wald χ²值	P值	OR值	95%CI
PDCD4	1.024	0.221	21.388	＜0.001	2.783	1.804~4.295
AIP	2.495	1.186	4.424	0.035	12.126	1.185~124.038
HDL-C	-3.134	1.770	3.134	0.077	0.044	0.001~1.399
hs-CRP	0.059	0.019	9.477	0.002	1.061	1.022~1.102
常量	-6.550	3.183	4.235	0.040	0.001	-

指标	AUC	SE值	95%CI	约登指数	敏感度（%）	特异度（%）
AIP	0.697	0.045	0.608~0.786	0.33	60.00	72.84
PDCD4	0.846	0.033	0.781~0.912	0.58	89.09	69.14
AIP联合PDCD4	0.849	0.033	0.784~0.913	0.62	92.73	69.14

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