Prognostic value of somatosensory evoked potentials, neuron-specific enolase, and S100 for short-term outcome in ischemic stroke

To predict short-term outcome in acute ischemic stroke, we analyzed somatosensory evoked potentials (SEP) and biochemical parameters [neuron-specific enolase (NSE) and S100 protein] in a prospective study with serial measurement. In 31 patients with 1st middle cerebral artery infarction, serum NSE and S100 protein were measured daily between days 1 and 6 poststroke. The N20 and N70 components of the SEP (SEP20 and SEP70) were determined on days 1 and 6. SEP and biochemical markers in stroke patients were compared with a control group. Short-term outcome was assessed by the modified Rankin Scale (mRS) at days 7-10 and was dichotomized between good (mRS 0–2) and poor (mRS ≥3) outcome. Specificity and positive predictive value (PPV) were high at day 1 for SEP (SEP20: 100% for both; SEP70: 93 and 88%, respectively) compared with lower values for NSE (67 and 50%) and S100 (23 and 57%). In contrast, S100 showed the highest sensitivity at day 1 with 77% compared with a relatively low sensitivity of NSE (31%) and SEP (SEP20: 35%, SEP70: 47%). The biochemical markers showed an improving sensitivity over time with best values (>90%) between days 3 and 4 at the expense of a lower specificity. Specificity and PPV of SEP on day 6 was still 100% with sensitivity increasing up to 53% (SEP20) and 60% (SEP70). SEP could early differentiate between good and poor outcome and reliably predict poor outcome. Since biochemical markers and SEP complement each other in the prognosis of stroke, a combined application of these markers seems promising.

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Abstract 29: Initial NIHSS Predicts Poor Short-term Outcome After Minor Stroke Even at Very Low Scores

Stroke ◽

10.1161/str.43.suppl_1.a29 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Jonathan M Raser ◽

Arthur Z Washington ◽

Koto Ishida ◽

Christina A Wilson ◽

Swaroop A Pawar ◽

...

Keyword(s):

Ischemic Stroke ◽

Substantial Proportion ◽

Minor Stroke ◽

Hospital Death ◽

Short Term ◽

Term Outcome ◽

Poor Outcome ◽

Short Term Outcome ◽

Minor Ischemic Stroke ◽

Iv Tpa

Background: Minor ischemic stroke patients often do not receive IV tPA due to mild or rapidly resolving symptoms as it is assumed that they will have excellent outcomes without treatment. Nevertheless, a substantial proportion of these patients have a poor outcome. It is unclear if this is due to factors such as preexisting disability, medical comorbidities, or recurrent stroke, or due to the deficits associated with the minor stroke, We hypothesized that initial stroke severity would predict poor short-term outcome even when the deficits are mild. Methods: We conducted a retrospective cohort study based on chart review of all patients with minor ischemic stroke, as defined by NIHSS≤6 at presentation, who were admitted to our hospital over a 30-month time period. Poor short-term outcome was defined by in-hospital death or discharge to any destination other than home. Results: Data were complete for 461 of 471 patients with minor stroke. A substantial proportion, 38% (95%CI 34-43%), had a poor short-term outcome, including 31% discharged to rehabilitation, 5% discharged to a nursing facility, and 2% dead or discharged to hospice. Impaired ambulation prior to admission was associated with a poor outcome (OR 3.4; 95%CI 1.1-10, p<0.03), but only present in 3% of patients. In multivariable analysis, poor outcome was strongly associated with initial NIHSS ( figure ; OR 1.5; 95%CI 1.3-1.7, p<0.001) and age (OR 1.04; 95%CI 1.03-1.06, p<0.001). Similarly, NIHSS predicted poor outcome when analysis was limited to initial NIHSS≤3 (OR 1.8; 95%CI 1.3-2.4, p<0.001). Of the 112 patients presenting within 4.5 hours of time last seen well, 15% received IV tPA and 45% were excluded solely due to mild or rapidly improving symptoms. NIHSS was lower in those patients excluded than in those who received tPA (median 2 vs. 5, p<0.001). After adjustment for age, NIHSS, and prior ambulatory status, there was no significant difference in poor outcome, which occurred in 42% of patients treated with tPA and 24% of those excluded due to mild or rapidly improving symptoms (OR 1.9 for poor outcome after tPA; 95%CI 0.4-9.5, p=0.43). Conclusions: More than one-third of patients with minor stroke had a poor short-term outcome, including nearly one-fourth of those who were excluded from IV tPA due to mild or rapidly improving symptoms. NIHSS was predictive of poor outcome at very low scores, consistent with the hypothesis that the deficits due to the initial stroke were responsible for poor outcome. However, the impact of tPA treatment in this population is uncertain.

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Role of neuron-specific enolase, glial fibrillar acidic protein and NR2-antibodies in early diagnostic of ischemic stroke

Translational Medicine ◽

10.18705/2311-4495-2021-8-5-5-20 ◽

2021 ◽

Vol 8 (5) ◽

pp. 5-20

Author(s):

A. D. Chaykovskaya ◽

M. P. Topuzova ◽

A. M. Makhanova ◽

A. G. Mikheeva ◽

D. S. Korotkova ◽

...

Keyword(s):

Ischemic Stroke ◽

Sensitivity And Specificity ◽

Neuron Specific Enolase ◽

Acidic Protein ◽

Short Term ◽

Term Outcome ◽

Acute Period ◽

Biomarker Panel ◽

Short Term Outcome ◽

Glial Fibrillar Acidic Protein

Background. Application of a biomarker panel during the acute period of the ischemic stroke (IS) can contribute to a more accurate and prompter diagnostics and verification of the optimal approach to a patients’ management.Objective. We aimed to clarify values of neuron-specific enolase (NSE), glial fibrillar acidic protein (GFAP) and antibodies for NMDA receptor’s NR2-subunit (NR2-antibodies) in the acute period of IS, to compare with such values in patients without IS, to assess their relationship with severity of neurological deficit and short-term outcome and also to establish sensitivity and specificity of the biomarker panel.Design and methods. 63 patients with IS and 31 people (11 with chronic brain ischemia and 20 healthy individuals) as controls were included. Results. NSE and GFAP values in IS group exceeded reference values at the onset of disease, lowering significally by 10-14 day, while NR2-antibodies’ values were lower at the onset of the disease compared with controls, rising by 10-14 day. In patients with unfavourable short-term outcome higher levels of NSE, GFAP and NR2-antibodies were found. A panel of such biomarkers has higher sensitivity and specificity than each of them individually.Conclusion. Researched substances can be used in a biomarker panel for IS diagnostics, brain damage monitoring, patient’s condition evaluation and short outcome prognosing.

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Association of Serum Albumin with Short-Term Outcome of Ischemic Stroke

Journal of National Institute of Neurosciences Bangladesh ◽

10.3329/jninb.v5i2.43012 ◽

2019 ◽

Vol 5 (2) ◽

pp. 101-105

Author(s):

Md Bakhtiar Azam ◽

AFM Al Masum Khan ◽

Muhammad Enayet Hussain ◽

Riaz Ferdaus ◽

Sirajee Shafiqul Islam ◽

...

Keyword(s):

Ischemic Stroke ◽

Serum Albumin ◽

Focal Cerebral Ischemia ◽

Experimental Studies ◽

P Value ◽

Short Term ◽

College Hospital ◽

Term Outcome ◽

Poor Outcome ◽

Short Term Outcome

Background: Serum albumin is proved to be a neuroprotective substance in experimental studies in focal cerebral ischemia. Objective: The aim of this study was to find out any association of serum albumin with the short term outcome of ischemic stroke. Methodology: This observational study was conducted in the Department of Neurology and Department of Internal Medicine at Dhaka Medical College Hospital, Dhaka from January 2011 to December 2011. A total of fifty consecutive patient with first ever ischemic stroke were included. Short term outcome was measured on day 7 using the modified Rankin Scale (mRS) and poor outcome was defined as mRS score 4 to 6 or death. Serum albumin was measured within 24 hours of onset of stroke. Result: Serum albumin was found to be significantly associated with the short-term outcome of ischemic stroke [P-value of Chi square (df = 1) was 0.010]. On logistic regression analysis, SA level [p = 0.018, Odds Ratio (OR) =5.817; 95% confidence interval: 1.348 to 25.106] remained significantly and positively associated with the short-term outcome of ischemic stroke. Conclusion: Serum albumin is significantly associated with the short-term outcome of ischemic stroke and lower level predicts poor outcome and higher level predicts good outcome. Journal of National Institute of Neurosciences Bangladesh, 2019;5(2): 101-105

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Troponin-I elevation predicts outcome after thrombolysis in ischemic stroke patients

The Egyptian Journal of Neurology Psychiatry and Neurosurgery ◽

10.1186/s41983-020-00256-2 ◽

2021 ◽

Vol 57 (1) ◽

Author(s):

Rania S. Nageeb ◽

Alaa A. Omran ◽

Wafaa S. Mohamed

Keyword(s):

Ischemic Stroke ◽

Troponin I ◽

Elevated Serum ◽

Stroke Patients ◽

Short Term ◽

Term Outcome ◽

Nihss Score ◽

Poor Outcome ◽

Short Term Outcome ◽

Group 1

Abstract Background Prognostic significance of troponin-I (T-I) elevation for poor short-term outcome in thrombolyzed ischemic stroke patients remains uncertain. Objectives To evaluate its role as a predictive biomarker of short-term outcome in thrombolyzed ischemic stroke patients. Methods This study included 72 acute ischemic stroke patients who were treated with intravenous thrombolytic therapy. All patients were subjected to clinical assessment and measurement of serum T-I level on admission. Outcome was assessed 3 months after stroke onset using the National Institute of Health Stroke Scale (NIHSS) and modified Rankin scale. Results Thirteen patients had elevated serum T-I level (group 1) and the remaining 59 were classified as group 2. Group 1 had a higher statistically significant older age, history of diabetes mellitus (DM), previous stroke, atrial fibrillation (AF), and admission NIHSS score, with significant decrease in high-density lipoprotein cholesterol (P < 0.05). Regarding the outcome of both groups, good outcome was significantly less common among group 1. Also, death was significantly more common among group I. Poor outcome in group 1 were significantly associated with older age, DM, AF, elevated serum T-I level at admission, and higher admission NIHSS score (P = 0.03, 0.04, 0.02, 0.05, and 0.001 respectively). The predictors of poor outcome in group 1 were elevated serum T-I level at admission, higher admission NIHSS score, and DM (P = 0.001, 0.02, and 0.05 respectively). Conclusion Elevated serum T-I levels on admission is a reliable prognostic predictor of poor outcome in thrombolyzed ischemic stroke patients. Trial registration ClinicalTrials.govNCT03925298 (19 April 2019) “retrospectively registered,”

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Role of some inflammatory biomarkers in prediction of short-term outcome in acute ischemic stroke

The Egyptian Journal of Neurology Psychiatry and Neurosurgery ◽

10.1186/s41983-021-00294-4 ◽

2021 ◽

Vol 57 (1) ◽

Author(s):

Yosria Abd Al Hameed AlTaweel ◽

Rania Sanad Nageeb ◽

Pakinam Mahmoud Metwally ◽

Ahmed Elsayed Badawy

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Stroke Severity ◽

Short Term ◽

Laboratory Assessment ◽

Term Outcome ◽

Neutrophil Lymphocyte Ratio ◽

Short Term Outcome ◽

Wbc Count

Abstract Background Several factors affect acute ischemic stroke (AIS) outcomes. Objective This study aimed to assess the role of the leukocyte count, neutrophil/lymphocyte ratio (NLR), and c reactive protein (CRP) as early predictors of outcome in AIS patients. Methods This study was conducted on 60 AIS patients. They were subjected to detailed history taking, clinical examination, brain imaging, and laboratory assessment including the CRP, white blood cell (WBC) count, absolute neutrophil count (ANC), absolute lymphocyte count (ALC), and NLR which is calculated by dividing ANC by ALC. Neurological scales were used to assess the level of consciousness by the Glasgow Coma Scale (GCS) and stroke severity by the National Institute of Health Stroke Scale (NIHSS) at the first 48 h of stroke onset as well as 1 week and 2 weeks later for the assessment of short-term functional neurological outcome. Results Sixty percent of the patients had unfavorable outcomes assessed by the Modified Rankin Scale (mRS). Patients with unfavorable outcomes had higher NIHSS scores. NLR was positively correlated with WBC count, ANC, and CRP. The higher WBC, NLR, and NIHSS, the unfavorable the outcome was. Conclusion The higher WBC, the NLR, and the level of CRP at the onset of AIS, the more severe stroke and the poorer the short-term outcome are expected.

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