Abstract: Objective  To investigate the correlation between short-term death and elevated serum amylase in acute stroke patients, and to evaluate the condition of patients early and predict the prognosis. 
Methods  The consecutive patients with acute stroke in department of emergency of Beijing Tiantan Hospital, Capital Medical University from January to December 2020 were enrolled in this retrospective study. The baseline clinical information and laboratory test results (CRP, serum amylase, lactic acid, glycohemoglobin, TC, TG) of the patients were recorded, and acute physiology and chronic health evaluation-Ⅱ (APACHE Ⅱ) score were calculated. According to serum amylase level, all patients were divided into high amylase group and normal amylase group. The clinical characteristics of two groups were compared. The data of 28-day all-cause mortality were collected. Univariate and multivariate logistic analysis was used to determine the independent risk factors of 28-day all-cause mortality. The efficacy of serum amylase in predicting 28-day all-cause mortality was analyzed by ROC curve. 
Results  CRP [(56.24±14.55) mg/L vs. (12.25±2.21) mg/L, P=0.029], blood lactic acid level [(4.25±1.25) mmol/L vs. (1.56±0.21) mmol/L, P=0.018] in high amylase group were higher than that in normal amylase group, and the all-cause mortality within 28 days [63(38.41%) vs.  21(5.80%), P=0.037] was higher than that in normal amylase group. Multivariate logistic regression analysis showed that baseline high NIHSS score (OR 2.79, 95%CI 1.71-4.55, P=0.003), high APACHE-Ⅱ score (OR 3.98, 95%CI 3.26-4.86, P<0.001), CRP>10 mg/L (OR 3.01, 95%CI 2.16-4.19, P=0.001), blood lactic acid>2.0 mmol/L (OR 2.92, 95%CI 1.77-4.82, P=0.002) and serum amylase>125 mmol/L (OR 3.78, 95%CI 2.44-5.86, P<0.001) were risk factors for 28-day all-cause mortality in stroke patients. ROC curve analysis showed that when the optimal cut-off value was 193 mmol/L, the AUC of serum amylase level predicting 28-day all-cause death was 0.754, the sensitivity was 0.912 and the specificity was 0.789.
Conclusions  The elevated serum amylase in acute stage is closely related to the all-cause mortality of stroke patients. Serum amylase has a relatively high predictive value for the risk of all-cause mortality within 28 days of stroke.

Key words: Serum amylase; Stroke; Prognosis; Risk of death; Predict

摘要： 目的 探讨卒中患者短期内死亡与血清淀粉酶升高的相关性，早期评估患者病情，预测预后。
方法 连续回顾性收集2020年1—12月在首都医科大学附属北京天坛医院急诊诊治的急性卒中患者。记录患者的基线临床资料以及实验室检查结果（CRP、血清淀粉酶、乳酸、糖化血红蛋白、TC、TG），计算急性生理及慢性健康评估Ⅱ（acute physiology and chronic health evaluation-Ⅱ，APACHE-Ⅱ）评分。根据血清淀粉酶水平，将患者分为高淀粉酶组和正常淀粉酶组，比较两组临床特点差异。采集患者28 d全因死亡数据，采用单因素和多因素分析患者28 d全因死亡的独立危险因素，进一步对血清淀粉酶预测28 d全因死亡的效能进行ROC分析。
结果 高淀粉酶组CRP[（56.24±14.55）mg/L vs.（12.25±2.21）mg/L，P=0.029]、血乳酸水平[（4.25±1.13）mmol/L vs.（1.56±0.21）mmol/L，P=0.018]高于正常淀粉酶组，28 d全因死亡率[63(38.41%) vs. 21(5.80%)，P=0.037]高于正常淀粉酶组。多因素logistic回归分析显示，NIHSS评分高（OR 2.79，95%CI 1.71～4.55，P=0.003）、APACHE-Ⅱ评分高（OR 3.98，95%CI 3.26～4.86，P＜0.001）、CRP＞10 mg/L（OR 3.01，95%CI 2.16～4.19，P=0.001）、血乳酸＞2.0 mmol/L（OR 2.92，95%CI 1.77～4.82，P=0.002）、血淀粉酶＞125 mmol/L（OR 3.78，95%CI 2.44～5.86，P＜0.001）是卒中患者28 d全因死亡的危险因素。ROC分析显示，当最佳截点值为193 mmol/L时，血清淀粉酶水平预测28 d全因死亡对应的AUC为0.754，敏感度为0.912，特异度为0.789。
结论 急性期血清淀粉酶升高与卒中患者短期全因死亡密切相关，血清淀粉酶对卒中患者28 d内卒中全因死亡风险的预测价值较高。

关键词: 血清淀粉酶; 卒中; 预后; 死亡风险; 预测