The Role of Platelet Distribution Width in the Association Between Blood Glucose and Neurological Impairment Severity in Acute Ischemic Stroke: A Moderated Mediation Model

Ning Rong,1 Zhi-Wei Li,1 Jian Yuan,2 Ze-Min Shao,2 Yun Deng,2 De-Sheng Zhu,2,3 Zhong-Wu Sun1 1Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, 230022, People’s Republic of China; 2Department of Neurology, Baoshan Branch, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200444, People’s Republic of China; 3Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, People’s Republic of ChinaCorrespondence: Zhong-Wu Sun, Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, 230022, People’s Republic of China, Tel +86-13805515857, Email [email protected] De-Sheng Zhu, Department of Neurology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, No. 160, Pujian Road, Shanghai, 200127, People’s Republic of China, Tel +86-13564719779, Email [email protected]: Fasting blood glucose (FBG) is a recognized risk factor for Ischemic Stroke, but little research has examined the interaction among FBG, Platelet Distribution Width (PDW) and the severity of neuronal damage. Thus, the present study constructs a moderated mediation model aimed to elucidate the relationships among FBG, PDW, and NIHSS scores in patients with acute ischemic stroke (AIS).Methods: We conducted a cross-sectional study on 431 AIS patients. Upon hospital admission, we assessed the patients’ NIHSS scores and collected blood samples to measure FBG and PDW levels. The relationship between FBG and NIHSS scores moderated by PDW was analyzed by linear curve fitting analysis, multiple linear regression analysis, and moderated mediation analysis respectively.Results: In the tertile grouping based on FBG, both PDW and NIHSS scores of AIS patients demonstrated an increase corresponding with rising levels of FBG (p< 0.001 for both). Multiple linear regression analysis revealed that, the β coefficients (95% CI) for the relationship between FBG and NIHSS scores were 1.49 (1.27– 1.71, p< 0.01) post-adjustment for potential confounders. The β coefficients (95% CI) for the relationship between FBG and PDW were 0.02 (0.01– 0.04, p< 0.01) post-adjustment. Likewise, for the relationship between PDW and NIHSS scores, the β coefficients (95% CI) were 4.33 (3.07– 5.59, p< 0.01) after adjustment. These positive association remained consistent in sensitivity analysis and hierarchical analysis. Smoothed plots suggested that there are linear relationships between FBG and PDW and NIHSS scores respectively. Further mediation analysis indicated that increased PDW significantly (p< 0.01) mediated 5.91% of FBG-associated increased NIHSS scores.Conclusion: This study suggested that FBG levels were associated with NIHSS scores, and the FBG-associated neurological impairment may be partially mediated by PDW. These findings underscore the importance of monitoring FBG and PDW levels in AIS patients, potentially guiding risk intervention strategies.Keywords: acute ischemic stroke, fasting blood glucose, platelet distribution width, multivariate analysis, mediation analysis