Role of combined determination of AVDL and LOI in short-term prognosis assessment of ACI patients

doi:10.3969/j.issn.1673-8640.2026.07.007

Abstract

Abstract:

Objective To investigate the role of combined determination of arteriovenous difference of lactate（AVDL）and lactic acid oxygenation index （LOI） in the short-term prognosis assessment of patients with acute cerebral infarction（ACI）. Methods A total of 500 patients with ACI from the Affiliated Brain Hospital of Nanjing Medical University from July 2023 to June 2025 were enrolled. The clinical data were collected，and arterial and venous blood lactic acid levels，arterial blood oxygen saturation and internal jugular venous blood oxygen saturation were determined. AVDL and LOI were calculated. All the patients were followed up for 28 d after discharge，and the short-term prognosis was evaluated using the modified Rankin scale （mRS），and they were classified into poor prognosis group（mRS score 3-6，136 cases）and good prognosis group（mRS score 0-2，364 cases）. Pearson correlation analysis was used to evaluate the correlation between AVDL，LOI and the National Institutes of Health Stroke Scale（NIHSS）score within 24 h after admission. Binary Logistic regression analysis was used to evaluate the risk factors for poor prognosis in ACI patients. The efficacy of single and combined determination models for judging poor prognosis in ACI patients was evaluated using receiver operating characteristic （ROC） curve. Results The volume of cerebral infarction，D-dimer（DD），stenosis degree of the responsible vessel and admission NIHSS score were higher in poor prognosis group than in good prognosis group （P<0.05），and the absolute values of AVDL and LOI were higher in poor prognosis group than those in good prognosis group（P<0.05）. AVDL，LOI and admission NIHSS score were negatively correlated（r values were -0.105 and -0.098，P<0.05）. Large cerebral infarction volume，high DD，high stenosis degree of the responsible vessel，large negative value of AVDL，large negative value of LOI and high admission NIHSS score were all risk factors for poor prognosis in ACI patients（P<0.05）. Based on the above 6 risk factors，a combined determination model for judging poor prognosis in ACI patients was constructed using Logistic regression analysis. The areas under curves（AUC）of single and combined determination models of cerebral infarction volume，DD，stenosis degree of the responsible vessel，AVDL，LOI and admission NIHSS score，as well as the combined model without AVDL and LOI，for judging poor prognosis in ACI patients were 0.916，0.749，0.815，0.797，0.675，0.738，0.959 and 0.935，respectively. Conclusions AVDL and LOI are related to the degree of neurological dysfunction in ACI patients. The combined determination model constructed based on cerebral infarction volume，DD，stenosis degree of the responsible vessel，AVDL，LOI and admission NIHSS score has high clinical value in the short-term prognosis assessment of ACI patients.

Key words: Arteriovenous difference of lactate, Lactic acid oxygenation index, Acute cerebral infarction, Neurological function, Correlation analysis

CLC Number:

R446.1

YE Kai, QUAN Heng, NIU Ziguang, LI Yanning, XIA Dongge, WENG Yiyi, ZHANG Lei. Role of combined determination of AVDL and LOI in short-term prognosis assessment of ACI patients[J]. Laboratory Medicine, 2026, 41(7): 657-663.

Figures/Tables 5

References 23

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组别	例数	年龄/岁	性别		既往病史
组别	例数	年龄/岁	男/[例（%）]	女/[例（%）]	糖尿病/[例（%）]	高血压/[例（%）]	高脂血症/[例（%）]	冠心病/[例（%）]
预后不良组	136	58.15±6.80	70（51.47）	66（48.53）	31（22.79）	26（19.12）	29（21.32）	23（16.91）
预后良好组	364	58.29±6.64	138（37.91）	226（62.09）	92（25.27）	74（20.33）	89（24.45）	64（17.58）
统计值		-0.204	0.021		0.328	0.091	0.537	0.031
P值		0.839	0.885		0.567	0.763	0.464	0.860
组别	吸烟史/[例（%）]	饮酒史/[例（%）]	脑梗死部位		脑梗死体积/mL		血压
组别	吸烟史/[例（%）]	饮酒史/[例（%）]	前循环/[例（%）]	后循环/[例（%）]	脑梗死体积/mL		收缩压/kPa	舒张压/kPa
预后不良组	42（30.88）	38（27.94）	72（52.94）	64（47.06）	20.88±4.01		19.32±2.03	11.36±1.36
预后良好组	118（32.42）	116（31.87）	180（49.45）	184（50.55）	13.05±4.22		19.30±1.98	11.25±1.42
统计值	0.107	0.716	0.483		-19.151		0.084	0.775
P值	0.743	0.397	0.487		<0.05		0.933	0.438
组别	Hb/（g·L^-1）	白细胞计数/（×10⁹L^-1）	TG/（mmol·L^-1）	HDL-C/（mmol·L^-1）	TC/（mmol·L^-1）		PT/s
预后不良组	134.65±15.27	8.57±2.16	1.89±0.48	1.06±0.21	4.61±1.13		12.40±1.43
预后良好组	135.05±15.05	8.44±2.23	1.85±0.51	1.05±0.20	4.43±1.15		12.30±1.439
统计值	-0.265	0.586	0.769	0.315	1.586		0.706
P值	0.791	0.558	0.442	0.753	0.113		0.481
组别	APTT/s	DD/（mg·L^-1）	责任血管狭窄程度/%	AVDL/（mmol·L^-1）	LOI		入院NIHSS评分/分
预后不良组	30.55±5.13	3.26±1.14	75.51±15.42	-0.38±0.13	-0.44±0.17		17.36±5.43
预后良好组	30.47±5.17	2.25±0.97	56.98±15.00	-0.25±0.11	-0.33±0.14		12.59±5.14
统计值	0.152	9.914	12.200	-12.411	-6.594		9.100
P值	0.879	<0.05	<0.05	<0.05	<0.05		<0.05

组别	例数	年龄/岁	性别		既往病史
组别	例数	年龄/岁	男/[例（%）]	女/[例（%）]	糖尿病/[例（%）]	高血压/[例（%）]	高脂血症/[例（%）]	冠心病/[例（%）]
预后不良组	136	58.15±6.80	70（51.47）	66（48.53）	31（22.79）	26（19.12）	29（21.32）	23（16.91）
预后良好组	364	58.29±6.64	138（37.91）	226（62.09）	92（25.27）	74（20.33）	89（24.45）	64（17.58）
统计值		-0.204	0.021		0.328	0.091	0.537	0.031
P值		0.839	0.885		0.567	0.763	0.464	0.860
组别	吸烟史/[例（%）]	饮酒史/[例（%）]	脑梗死部位		脑梗死体积/mL		血压
组别	吸烟史/[例（%）]	饮酒史/[例（%）]	前循环/[例（%）]	后循环/[例（%）]	脑梗死体积/mL		收缩压/kPa	舒张压/kPa
预后不良组	42（30.88）	38（27.94）	72（52.94）	64（47.06）	20.88±4.01		19.32±2.03	11.36±1.36
预后良好组	118（32.42）	116（31.87）	180（49.45）	184（50.55）	13.05±4.22		19.30±1.98	11.25±1.42
统计值	0.107	0.716	0.483		-19.151		0.084	0.775
P值	0.743	0.397	0.487		<0.05		0.933	0.438
组别	Hb/（g·L^-1）	白细胞计数/（×10⁹L^-1）	TG/（mmol·L^-1）	HDL-C/（mmol·L^-1）	TC/（mmol·L^-1）		PT/s
预后不良组	134.65±15.27	8.57±2.16	1.89±0.48	1.06±0.21	4.61±1.13		12.40±1.43
预后良好组	135.05±15.05	8.44±2.23	1.85±0.51	1.05±0.20	4.43±1.15		12.30±1.439
统计值	-0.265	0.586	0.769	0.315	1.586		0.706
P值	0.791	0.558	0.442	0.753	0.113		0.481
组别	APTT/s	DD/（mg·L^-1）	责任血管狭窄程度/%	AVDL/（mmol·L^-1）	LOI		入院NIHSS评分/分
预后不良组	30.55±5.13	3.26±1.14	75.51±15.42	-0.38±0.13	-0.44±0.17		17.36±5.43
预后良好组	30.47±5.17	2.25±0.97	56.98±15.00	-0.25±0.11	-0.33±0.14		12.59±5.14
统计值	0.152	9.914	12.200	-12.411	-6.594		9.100
P值	0.879	<0.05	<0.05	<0.05	<0.05		<0.05

项目	β值	标准误	Wald值	P值	OR①值（95%CI②）
脑梗死体积	0.541	0.080	45.281	<0.05	1.718（1.468~2.011）
DD	0.852	0.247	11.917	<0.05	2.344（1.445~3.803）
责任血管狭窄程度	0.104	0.019	29.672	<0.05	1.109（1.069~1.152）
AVDL	-15.403	2.767	30.991	<0.05	0.000（0.000~0.002）
LOI	-3.453	1.441	5.739	<0.05	0.017（0.002~0.534）
入院NIHSS评分	0.213	0.049	19.073	<0.05	1.237（1.124~1.361）

项目	β值	标准误	Wald值	P值	OR①值（95%CI②）
脑梗死体积	0.541	0.080	45.281	<0.05	1.718（1.468~2.011）
DD	0.852	0.247	11.917	<0.05	2.344（1.445~3.803）
责任血管狭窄程度	0.104	0.019	29.672	<0.05	1.109（1.069~1.152）
AVDL	-15.403	2.767	30.991	<0.05	0.000（0.000~0.002）
LOI	-3.453	1.441	5.739	<0.05	0.017（0.002~0.534）
入院NIHSS评分	0.213	0.049	19.073	<0.05	1.237（1.124~1.361）

项目	AUC（95%CI）	最佳临界值	敏感性/%	特异性/%	Youden指数
脑梗死体积	0.916（0.885~0.938）	18.48 mL	77.2	80.7	0.579
DD	0.749（0.699~0.799）	2.89 mg·L^-1	65.4	74.5	0.399
责任血管狭窄程度	0.815（0.773~0.857）	68%	75.0	77.7	0.527
AVDL	0.797（0.752~0.842）	-0.31 mmol·L^-1	71.7	73.5	0.452
LOI	0.675（0.619~0.731）	-0.43	74.7	55.9	0.306
入院NIHSS评分	0.738（0.689~0.787）	18分	48.5	83.8	0.323
联合检测模型	0.959（0.944~0.975）	0.757	97.1	92.7	0.898
剔除AVDL、LOI后的联合检测模型	0.935（0.913~0.957）	0.720	89.0	83.2	0.722