Abstract TP223: Role of Plasma Biomarkers in Diagnosis of Ischemic Stroke Subtypes

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Svetlana Lorenzano ◽  
Natalia S Rost ◽  
Ken Arai ◽  
Tijy Thankachan ◽  
Rebecca E Green ◽  
...  

Objectives: Identifying underlying stroke etiology plays critical role in acute management and secondary prevention strategies. Despite advanced diagnostics, up to 35% of ischemic strokes (IS) remain undetermined. We sought to evaluate the association between IS subtypes and plasma levels of biomarkers as representative of distinct etiologies underlying stroke subtypes. Methods: We prospectively measured plasma high sensitivity-C reactive protein (hs-CRP), matrix metalloproteinase (MMP)-2 and MMP-9, F2-isoprostane (F2-isoP), Oxygen Radical Absorbance Capacity assay (ORAC), homocysteine and urinary 8-hydroxydeoxyguanosine (8OHdG), in patients presenting within 9 hours from acute ischemic stroke (AIS) onset. Stroke subtype was assigned by a stroke neurologist according to the Causative Classification of Stroke System (CCSS) criteria. Results: There were 489 AIS subjects enrolled in this study [mean (SD) age 70.1 (15.1) y; 43.4% female; median (IQR) NIHSS 6 (3-13); 40.7% received IV tPA]. Among these AIS, 51% were of cardioembolic (CE), 17% of atherothrombotic, 7% of lacunar, 5% of other, and 20% of undetermined subtype. Patients with CE stroke were older and more likely to be female, non-smokers, have atrial fibrillation and congestive heart failure, but not carotid stenosis (all p<0.05). CE stroke subtype was also associated with greater stroke severity, and baseline levels of MMP-2 (p= 0.001) and ORAC (p= 0.008), as compared to other CCSS subtypes. In multivariate logistic regression analysis including all univariate predictors with p<0.05 as well as treatment with IV t-PA, baseline MMP-2 (OR 2.8, 95% CI 1.3-5.8; p= 0.006) and ORAC (OR 2.6, 95% CI 1.3-5.1; p= 0.007) was independently associated with CE stroke subtype. Conversely, the “other” stroke subtype was associated with lower levels of MMP-2 (OR 0.1, 95% CI 0.02-0.3; p= 0.001), and homocysteine levels were independently correlated with undetermined subtype (OR 2.2, 95% CI 1.2-4.1; p= 0.008). Conclusions: In AIS patients, hyperacute plasma biomarkers are associated with specific stroke subtypes, reflective of the underlying pathophysiology. If validated in future studies, plasma biomarkers may play valuable role in early diagnosis and guide management of specific AIS subtypes.

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Jae Guk Kim ◽  
Youngchai Ko ◽  
Soo Joo Lee

Background and Objectives: Inflammation plays an important role in atherosclerosis and its clinical sequelae. Their relationship to stroke is not settled. We assessed the hypothesis that relative elevations of high-sensitivity C-reactive protein (hs-CRP) and lipoprotein-associated phospholipase A2 (Lp-PLA2) levels at the time of first stroke are associated with stroke severity and prognosis. Methods: First ischemic stroke patients who was admitted within 7days after stroke onset, were prospectively enrolled. High-sensitivity C-reactive protein and Lp-PLA2 level were assayed using the enzyme-linked immunoassay. Vascular risk factors, stroke subtypes, and initial stroke severity were assessed. Stroke severity was evaluated using the National Institutes of Health Stroke Scale (NIHSS) and was categorized as mild (NIHSS score<6), moderate (NIHSS score of 6-13), or severe (NIHSS score≥14). The unfavorable outcome was defined as the modified Rankin Scale of 2-6 at 3month after stroke onset. Results: Two hundred two patients (mean age, 67.5 years; 52.5% male) were included; 104 (51.5%) had unfavorable outcome. Levels of hs-CRP and Lp-PLA2 were weakly correlated (Spearman’s rho=0.174, p=0.01). In univariate analyses, female (p=0.03), patients with large artery atherosclerosis of stroke subtypes (p<0.01), severe NIHSS score (p=0.01), and unfavorable outcome (p<0.01) showed the higher mean value level of hs-CRP level than the others. Patients with hypertension (p=0.03), large artery atherosclerosis (p<0.01), severe NIHSS score (p<0.01), and unfavorable outcome (p=0.01) also had the higher mean value of Lp-PLA2 level than the others. After adjusting for age, sex, vascular risk factors, and initial stroke severity, the high level of hs-CRP was associated with unfavorable outcome (1.71±4.2 vs. 0.26±0.45, odds ratio (OR) 1.82, 95% confidence interval (CI) 1.02-3.27, p=0.04). However, after adjusting for the confounders, Lp-PLA2 was not associated with unfavorable outcome (191.33±77.78 vs. 162.02±61.54, OR 1.00, 95% CI 0.99-1.01, p=0.66). Conclusion: Our findings suggest that the level of hs-CRP and Lp-PLA2 were associated with stroke severity, but only hs-CRP may be useful to predict functional outcome at 3 month after ischemic stroke.


2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Xiping Gong ◽  
Xinying Zou ◽  
Liping Liu ◽  
Yuehua Pu ◽  
Yilong Wang ◽  
...  

Background and Purpose. Inflammation exists in inception, progression, and reperfusion of acute ischemic stroke. Insightful understanding of correlation in inflammatory mediators and stroke severity with intracranial artery stenosis may improve rational stroke therapy.Methods. We prospectively recruited 977 patients with acute noncardioembolic ischemic stroke with MCA stenosis by MRA as none to mild (<50%), moderate (50–69%), severe (70–99%), or occlusive (100%). The peripheral levels of WBC, homocysteine (HCY), and high sensitivity C-reactive protein (hs-CRP) were recorded. All patients were assessed of 1-year outcome by mRS as favorable (0–2) or poor (3–6).Results. The levels of WBC, HCY, and hs-CRP had no significant differences in patients with categorized MCA stenosis (all . Higher levels of WBC, HCY, and hs-CRP were found in patients with 1-year poor outcome (all , but only hs-CRP is an independent predictor (OR 1.06, 95% CI 1.027–1.093, . The combination of any two of increased hs-CRP (>3 mg/L), WBC (>6.91 × 109/L), and HCY (>15 μmol/L) had higher power in predicting 1-year poor outcome than the single elevated mediator.Conclusions. Elevated hs-CRP independently predicts 1-year poor outcome in acute stroke. The combination of increased hs-CRP, WBC, or HCY had a stronger predictive value in poor outcome than individual elevated mediator.


2020 ◽  
Vol 9 (12) ◽  
pp. 3838
Author(s):  
Soo Ji Jeon ◽  
Hyung Bin Hwang ◽  
Na Young Lee

The purpose of this study was to investigate the function of the renin–angiotensin–aldosterone system (RAAS) in normal tension glaucoma (NTG) patients by measuring the level of renin and angiotensin II (AngII) in the plasma. Twenty-four patients with NTG and 38 control subjects were included in this study. Renin and AngII were measured in the blood samples of all subjects by enzyme-linked immunosorbent assay (ELISA). No significant differences were found in the complete blood count, fasting glucose, low-density lipoprotein (LDL), and high-sensitivity C-reactive protein (hs-CRP) levels between the control and NTG groups. The systemic concentration and variability of the renin concentration in the blood was significantly higher in the NTG group (p = 0.005 and 0.005, respectively). According to multivariate logistic regression analysis, the variability of the renin concentration was associated with NTG (p = 0.006). In conclusion, the systemic concentration and variability of renin levels were elevated in NTG patients. An altered renin concentration could represent a difference in RAAS function in NTG patients.


2017 ◽  
Vol 24 (10) ◽  
pp. 1039-1047 ◽  
Author(s):  
Kazuo Kitagawa ◽  
Naohisa Hosomi ◽  
Yoji Nagai ◽  
Tatsuo Kagimura ◽  
Toshiho Ohtsuki ◽  
...  

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Souvik Sen ◽  
Steven Offenbacher ◽  
Kevin Moss ◽  
Lauren D Giamberardino ◽  
Wayne Rosamond

Introduction: Epidemiological studies have shown that serum inflammatory markers are independently associated with ischemic stroke. We assessed the hypothesis that specific inflammatory mediator is associated with specific ischemic stroke subtypes in the Atherosclerosis Risk in Communities (ARIC) study. Methods: In the ARIC study, serum inflammatory mediators were assessed in a cohort of subjects without prior stroke. They included high sensitivity C-reactive protein (hs-CRP), interleukin 1ra (IL-1ra), and Intercellular Adhesion Molecule 1(sICAM1) and were followed for all vascular events. All stroke events were adjudicated and classified into stroke subtypes by standard definitions. Multivariable Cox proportional hazards models were used to study the relationship between elevated inflammatory markers (upper quartile compared with lower three quartiles) and ischemic stroke, as well as stroke subtypes (cardioembolic, lacunar or thrombotic). Results: At the fourth ARIC study visit, serum inflammatory mediators were assessed in a cohort of 5663 subjects (mean age±SD=62.3±5.6, 55% female, 83% white and 17% African-American). Over a 15-year follow-up, 237 (4.2%) subjects had incident ischemic stroke of which 47% were thrombotic, 26% were cardioembolic, and 20% were of the lacunar stroke subtype. After adjustment for Race/Center, Age, Gender, BMI, Hypertension, Diabetes, LDL Level, Smoking (3-levels), Pack Years, Education (3-levels), hs-CRP (adjusted HR 1.45, 95% CI 1.08-1.96), IL-1ra (adjusted HR 1.90, 95% CI 1.09-3.28) and sICAM1(adjusted HR 1.33, 95% CI 1.0-1.78) were associated with overall ischemic stroke. This was driven by associations between hs-CRP and thrombotic stroke (adjusted HR 1.73, 95% CI 1.14-2.61), IL-1ra and cardioembolic stroke (adjusted HR 3.42, 95% CI 1.23-9.53), and sICAM-1 and lacunar stroke (adjusted HR 1.92, 95% CI 1.05-3.50). Conclusions: Results from this prospective show an independent association between serum inflammatory mediators and incident ischemic stroke. These associations appear to be attributed to the association between specific inflammatory mediator and individual stroke subtype. These results shed light to the mechanism by which inflammatory mediators contribute to stroke risk.


Author(s):  
Yun Luo ◽  
Zhongyuan Wang ◽  
Jingwei Li ◽  
Yun Xu

Objective:The aim of this retrospective study was to investigate if elevated C reactive protein (CRP) was related to the stroke severity, and to analyze its different distribution in stroke subtypes.Methods:316 patients with acute ischemic stroke (AIS) were enrolled and had CRP determinations; they were dichotomized as<7 or ≥7mg/L according to the previous report. 128 patients with transient ischemic attack who also had CRP measurements were selected as controls. A possible level-risk relationship between elevated CRP and NIHSS, which considered relatively severe illness as a value≥8, was studied within the AIS group.Results:CRP was elevated in 21% of the AIS compared to 4% in the control group (p = 0.000). Within the AIS group, patients with CRP levels ≥7mg/L had a significantly increased risk of severe stroke (OR 3.33, 95% CI 1.84-6.00, p =0.00). In subtype stroke, the highest rate of elevated CRP and NIHSS were in those with cardioembolic stroke (CE) using TOAST classification, total anterior circulation infarction (TACI) of OCSP classification and large volume infarction (LVI) of Adams classification; the odds ratio(OR) between elevated CRP and NIHSS was 6.14 (95% CI 1.43-26.44) in CE, 1.714 (95% CI 1.30-2.26) in TACI, 2.32 (95% CI 1.08-4.99) in LVI, and the p value were all below 0.05.Conclusion:Elevated CRP level can reflect the severity of AIS, which was association with stroke subtype.


BMC Neurology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Pengyu Gong ◽  
Yukai Liu ◽  
Ting Huang ◽  
Wenxiu Chen ◽  
Teng Jiang ◽  
...  

Abstract Background A fraction of patients with penetrating artery infarction (PAI) experience progressive motor deficit deterioration (PMD). We sought to investigate the role of high-sensitivity C-reactive protein (hs-CRP) at admission in predicting PMD. Methods From January 2015 to September 2018, consecutive patients with PAI from three centers were prospectively enrolled in this study. PMD was defined as worsening of motor function score by ≥1 point on the National Institutes of Health Stroke Scale during the first 5 days after admission. Multivariable logistic regression analyses were performed to explore the relationship between hs-CRP and PMD in patients with PAI. We also performed receiver operating characteristic curve analysis and constructed a nomogram to assess the overall discriminative ability of hs-CRP in predicting PMD. Results We ultimately included 544 patients (mean age, 65.4 ± 11.8 years). A total of 85 (15.6%) patients were identified to have PMD. Multivariate logistic regression analysis showed that hs-CRP was independently associated with PMD (P = 0.001). The optimal cutoff value for hs-CRP as a predictor for PMD was 3.48 mg/L, with a sensitivity of 73.64% and a specificity of 82.35% (area under curve, 0.792). Moreover, the nomogram we constructed indicated that higher level of hs-CRP was an indicator of PMD (c-index = 0.780, P < 0.001). Conclusions Our study suggested that hs-CRP might be a useful biomarker for predicting the risk of PMD in patients with PAI.


Author(s):  
Tissi Liskawini Putri ◽  
Ratna Akbari Ganie ◽  
Aldy S. Rambe

Proses inflamasi merupakan perjalanan penyakit dari strok iskemik akut, yang melibatkan penumpukan mediator inflamasi daninfiltrasi leukosit. Nilai Rasio Neutrofil-Limfosit (RNL) di beberapa penelitian dapat digunakan untuk meramalkan strok akibat iskemikakut yang caranya mudah dilakukan. High sensitivity C Reactive Protein (hs-CRP) merupakan reaktan tahap akut yang kadarnyameningkat di strok iskemik. Oleh karena itu bermanfaat sebagai petanda peramal hal terkait. Penelitian ini bertujuan untuk mengetahuiperbedaan nilai antara RNL dan hs-CRP dalam meramalkan hasilan pasien strok iskemik akut. Metode penelitian analitik observasionaldengan rancangan kohort prospektif. Hasil dinilai dengan modified Rankin Scale (mRS) (1–2=baik; 3–6=buruk) dan Barthel Index (BI)(0–20=ketergantungan jumlah keseluruhan, 21-60=berat; 1–90=sedang; 91–99=ringan dan 100=normal). Dari 43 sampel, didapatkanlaki-laki 24 orang (55,8%) dan perempuan 19 orang (44,2%) dengan rerata usia 57,12 ± 9,8 tahun. hubungan positif didapatkansedang dan bermakna antara RNL dengan hasilan mRS dan BI pasien strok iskemik akut (r=0,585; p=0,001 dan r=0,564; p=0,001).Hubungan positif didapatkan kuat dan bermakna antara hs-CRP dan hasilan mRS (r=0,614; p=0,001) serta didapatkan hubunganpositif dengan kekuatan sangat kuat dan bermakna antara hs-CRP dan hasilan n BI pasien strok iskemik akut (r=0,881; p=0,001).Dengan membandingkan ketepatan kedua data didapatkan RNL 86% dan hs-CRP 88% (p=0,6554). Perbedaan tidak bermakna terdapatantara nilai RNL dan hs-CRP sebagai peramal hasilan pasien strok iskemik akut.


BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e021232 ◽  
Author(s):  
Chul-Hyun Park ◽  
Jong Geol Do ◽  
Yong-Taek Lee ◽  
Kyung Jae Yoon

ObjectivesTo evaluate the association between high-sensitivity C-reactive protein (hs-CRP) and sarcopenic obesity, and to determine age or sex differences underlying the relationship between hs-CRP and sarcopenic obesity.DesignObservational study.ParticipantsThe study included 237 838 participants whose body composition and hs-CRP were analysed at the two health promotion centres in South Korea. Participants were divided into four groups based on body composition: normal, obesity only, sarcopenia only and sarcopenic obesity.Primary measuresThe levels of hs-CRP and proportion of participants with high (≥1.0 mg/L) hs-CRP. Sarcopenic obesity was defined as subjects fulfilling the criteria for sarcopenia (below 2 SD of mean of Skeletal Muscle Mass Index for young adults) and obesity (waist circumference ≥90 cm for men and ≥85 cm for women).ResultsThe level of hs-CRP was highest in the sarcopenic obesity group. Following adjustment for various confounders including age, sex, comorbidities, metabolic, health-related behaviour and demographic factors, the adjusted ORs (95% CI) for subjects with high hs-CRP associated with obesity, sarcopenia and sarcopenic obesity compared with normal group (reference) were 1.17 (1.05 to 1.31), 2.23 (1.21 to 4.07) and 3.23 (2.71 to 3.83), respectively. In age subgroup analyses, multivariate logistic regression analysis revealed that the association of high hs-CRP with sarcopenic obesity was stronger in younger (<60 years) participants than in older (≥60 years) participants (p for interaction <0.001). In subgroup analyses for sex, the association of high hs-CRP with sarcopenic obesity was higher in female participants than in males (p for interaction <0.001).ConclusionsThis study demonstrated that high level of hs-CRP was independently associated with sarcopenic obesity in Korean population. We found for the first time that there was a strong association between increased hs-CRP and sarcopenic obesity in female and younger (<60 years) subjects.


2020 ◽  
Vol 3 (2) ◽  
pp. 48
Author(s):  
Stefanus Erdana Putra ◽  
Fauzi Novia Isnaening Tyas ◽  
Muhammad Hafizhan ◽  
Raden Ajeng Hanindia Riani Prabaningtyas ◽  
Diah Kurnia Mirawati

<p><strong>Pendahuluan:</strong><strong> </strong><em>Stroke</em> adalah penyebab utama kecacatan jangka panjang dengan dampak klinis dan sosial ekonomi yang signifikan di seluruh dunia. Hiperlipidemia dan inflamasi memainkan peranan penting dalam patofisiologi <em>stroke</em> iskemik. Meskipun <em>high-sensitivity C-Reactive Protein </em>(hs-CRP) dan kadar lipid merupakan penentu risiko penyakit pembuluh darah, kekuatan penggunaan <em>biomarker</em> ini dalam penentuan prognosis <em>stroke </em>iskemik belum dapat dipastikan. Penelitian ini bertujuan untuk mengetahui hubungan kadar hs-CRP dan profil lipid pada pasien <em>stroke </em>iskemik akut di Rumah Sakit Universitas Sebelas Maret dan memahami hubungan antara <em>biomarker</em> tersebut dengan <em>outcome</em> jangka pendek.</p><p><strong>Metode penelitian:</strong><strong> </strong>Penelitian <em>cross-sectional</em> dilakukan pada 34 pasien dengan serangan <em>stroke</em> iskemik pertama kali. Profil lipid dan hs-CRP diukur pada hari pertama masuk rumah sakit. Defisit neurologis diukur menggunakan <em>National Institutes of Health Stroke Scale</em> (NIHSS) dan <em>outcome</em> diukur menggunakan Barthel <em>Index</em> pada hari ke-7 perawatan di unit <em>stroke</em>. Selanjutnya, kadar serum hs-CRP dan profil lipid dianalisis korelasinya dengan defisit neurologis dan <em>outcome</em> jangka pendek.</p><p><strong>Hasil penelitian:</strong><strong> </strong>Pasien <em>stroke</em> iskemik memiliki kadar hs-CRP, kolesterol total (TC), trigliserida (TG), <em>low-density lipoprotein</em> (LDL) yang lebih tinggi; serta kadar <em>high-density lipoprotein</em> (HDL) yang lebih rendah dari kriteria normal. Berdasarkan uji korelasi Pearson, LDL memiliki korelasi signifikan dengan NIHSS (r = 0,447; p = 0,008) sedangkan hs-CRP memiliki korelasi signifikan yang lebih kuat dengan Barthel <em>Index </em>daripada NIHSS (r = -0,412; p = 0,015). TC dan HDL juga memiliki korelasi signifikan dengan NIHSS.</p><p><strong>Kes</strong><strong>impulan:</strong><strong> </strong>Penelitian ini menunjukkan bahwa profil lipid dan hs-CRP dapat digunakan sebagai prediktor prognosis <em>outcome stroke </em>iskemik akut.</p><p> </p><p>Introduction: Stroke is the leading cause of long-term disability with significant clinical and socioeconomic impact worldwide. Hyperlipidemia and inflammation play major roles in ischemic stroke. While high-sensitivity C-Reactive Protein (hs-CRP) and lipid levels are established risk determinants for vascular disease, the relative strength of these biomarkers for ischemic stroke is uncertain. The purpose of this study is to investigate the association of hs-CRP levels and lipid profile in acute ischemic stroke patients and understand correlation between those markers and short-term outcome.</p><p>Methods: This was a cross-sectional study of 34 first-timer ischemic stroke patients. Lipid profiles and hs-CRP were measured on admission day. The neurological deficit was quantified using National Institutes of Health Stroke Scale (NIHSS) and outcome was quantified using Barthel Index at the 7th day in stroke unit. Serum level of hs-CRP and lipid profile were estimated and correlated with neurological deficit and short-term outcome.</p><p>Results: Ischemic stroke patients had higher levels of hs-CRP, total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL); and lower level of high-density lipoprotein (HDL) than normal criteria. Based on Pearson correlation test, LDL had significant correlation with NIHSS (r=0.447; p=0.008) while hs-CRP had stronger significant correlation with Barthel Index than NIHSS (r=-0.412; p=0.015). TC and HDL also had significant correlation with NIHSS.</p><p>Conclusions: This research suggests that lipid profile and hs-CRP can be used as predictors of prognosis for acute ischemic stroke outcome. Keywords: Barthel index, C-reactive protein, National Institutes of Health Stroke Scale, lipid profile, ischemic stroke.</p>


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