Oxidized Albumin and Cartilage Acidic Protein-1 as Blood Biomarkers to Predict Ischemic Stroke Outcomes

Background: There is high demand for blood biomarkers that reflect the therapeutic response or predict the outcomes of patients with acute ischemic stroke (AIS); however, few biomarkers have been evidentially verified to date. This study evaluated two proteins, oxidized albumin (OxHSA) and cartilage acidic protein-1 (CRTAC1), as potential prognostic markers of AIS.Methods: The ratio of OxHSA to normal albumin (%OxHSA) and the level of CRTAC1 in the sera of 74 AIS patients were analyzed on admission (day 0), and at 1 and 7 days after admission. AIS patients were divided into two groups according to their modified Rankin Scale (mRS) at 3 months after discharge: the low-mRS (mRS < 2) group included 48 patients and the high-mRS (mRS ≥ 2) group included 26 patients. The differences in %OxHSA and CRTAC1 between the two groups on days 0, 1, and 7 were evaluated.Results: The mean %OxHSA values of the high-mRS group on days 0, 1, and 7 were significantly higher than those of the low-mRS group (p < 0.05). The CRTAC1 levels continuously increased from day 0 to day 7, and those of the high-mRS group were significantly higher than those of the low-mRS group on day 7 (p < 0.05).Conclusions: These results suggest that higher %OxHSA and CRTAC1 are associated with poor outcomes in AIS patients. An index that combines %OxHSA and CRTAC1 can accurately predict the outcomes of AIS patients.

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Abstract TP148: The Hydration Influence on the Risk of Ischemic Stroke Outcomes (THIRST-EXPANSION STUDY)

Stroke ◽

10.1161/str.44.suppl_1.atp148 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Mohammad Moussavi ◽

Gustavo Rodriguez ◽

Joseph Alario ◽

Ravjot Sodhi ◽

Aaron Nizam ◽

...

Keyword(s):

Ischemic Stroke ◽

Negative Impact ◽

Serum Osmolality ◽

Hydration Status ◽

Stroke Severity ◽

Past Study ◽

Stroke Patients ◽

Stroke Outcomes ◽

Significant Difference ◽

The Mean

Introduction: Extensive studies have not been done in patients presenting with ischemic stroke regarding hydration status. It is unclear whether all of the elements of hydration status affect disability on discharge. Our past study suggests that high serum osmolality has a negative impact on ischemic stroke severity. This continuation of our prior study aims to test the effect of all laboratory elements of dehydration on severity and outcome of ischemic stroke patients. Methods: We conducted a retrospective analysis of ischemic stroke patients admitted between 2004 and 2009 at a community teaching hospital. Serum BUN/Creatinine and serum osmolality (sOsm) was calculated at initial presentation. sOSm, BUN/Cr, hematocrit and bicarbonate levels were analyzed for association with NIHSS and mRS. Patients were divided into two groups by sOsm as follows: (1) sOsm < 295, (2) sOsm ≥ 295; and two groups by BUN/Cr as follows: (3) BUN/Cr < 20, (4) BUN/Cr ≥ 20. Discharge mRS score was compared between (1) and (2); and (3) and (4) to determine the effect of sOsm and BUN/Cr on stroke outcomes. All data was analyzed using SPSS software version 20. Results: Of 1350 patients, 543 (mean age = 72.5 +/-14.2, 56% female) were included. There was a significant difference between the mean admission NIHSS in (1) 8.57, n = 222 and (2) 7.09, n = 319, p < .05 and between (3) 8.90, n = 219 and (4) 6.87, n = 322, p < .05. There was a significant difference in the mean mRS score between (1) 2.92, n = 222 and (2) 2.54, n = 317, p < .05, and (3) 2.92, n = 218 and (4) 2.56, n = 321, p < .05. The same results were found when comparing discharge sOsm values to predict patient outcome. Discharge sOsm correlated with mRS (r = .147, p < .05). Initial BUN/Cr correlated with NIHSS (r = .128, p < .05) and mRS (r = .107, p < .05) and final BUN/Cr with mRS (r = .161, p < .001). Bicarbonate levels at admission correlated with NIHSS at admission (r = -0.134), p < 0.05. Hematocrit levels at discharge correlated with mRS (r= -0.183), p <0.001. Conclusion: Our study suggests that patients with BUN/Cr and sOsm above normal levels at admission and dishcarge have worse outcome at discharge. We also found a correlation between other laboratory variables of dehydration status, namely hematocrit levels and outcome. A future prospective randomized study is warranted.

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Abstract 3086: Safety of Induced Hypertension in Acute Ischemic Stroke Patients with Suboptimal Recanalization after Endovascular Thrombolysis.

Stroke ◽

10.1161/str.43.suppl_1.a3086 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Steve M Cordina ◽

Shahram Majidi ◽

Saqib A Chaudhry ◽

Ameer E Hassan ◽

Gustavo J Rodriguez ◽

...

Keyword(s):

Ischemic Stroke ◽

Endovascular Treatment ◽

Acute Ischemic Stroke ◽

Odds Ratio ◽

Multivariate Logistic Regression Analysis ◽

Norepinephrine Infusion ◽

Induced Hypertension ◽

The Mean ◽

Poor Outcomes ◽

Similar Risk

Background: Induced hypertension is feasible, likely safe and can improve neurologic deficits in patients who are not candidates for thrombolysis. The safety of inducing hypertension in post-thrombolytic patients with suboptimal recanalization after endovascular thrombolysis is not currently known. Objective: To determine the feasibility and safety of inducing hypertension in patients in the acute post thrombolytic phase. Methods: We analyzed retrospectively collected data from a database of patients who presented with acute ischemic stroke and who received endovascular treatment with or without intravenous (IV) r-tPA . Patients with suboptimal recanalization after endovascular thrombolysis underwent induction of hypertension (systolic blood pressure [SBP] target 140-180 mmHg) for a 24 hour period after an immediate post-procedure CT scan did not demonstrate any intracerebral hemorrhage (ICH). We determined the rate of symptomatic ICH (sICH), and outcome based on modified Rankin score (mRS) at the time of discharge and compared these data to those observed in patients with non-induced hypertension and normotension. Multivariate logistic regression analysis was used to identify the odds ratio of neurological worsening and/or death after adjusting for initial National Institute of Health Stroke Scale (NIHSS) score and success of hypertension induction, which was defined as a sustained mean BP of ≥ 30% above the admission BP over the first 24 hours. Results: A total of 16 patients (12%, mean age 66) underwent post-thrombolytic induced hypertension among 138 patients who were treated with endovascular treatment. The mean age (± standard deviation [SD]) of treated patients was 68 (± 15.3) years and 52 (46%) were women. Hypertension was induced using intravenous phenylephrine or norepinephrine infusion in 9 and 7 patients, respectively. The mean (±SD) increase in SBP was 140 (±16.4) mmHg. In multivariate analysis, patients with post-thrombolytic induced hypertension had similar risk of sICH (odds ratio [OR] 0.98, 95% confidence interval [CI] 0.11-8.55) and similar discharge mRS (OR 1.85, 95% CI 0.50-6.84). Conclusion: There was no observed increase in sICH or poor outcomes associated with induced hypertension in patients with suboptimal recanalization after endovascular thrombolysis supporting safety. Further trials directed towards assessing efficacy of this approach are needed.

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Braden Scale for Assessing Pneumonia After Acute Ischemic Stroke

10.21203/rs.2.10382/v1 ◽

2019 ◽

Author(s):

Yunlong Ding ◽

Yazhou Yan ◽

Jiali Niu ◽

Yanrong Zhang ◽

Zhiqun Gu ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Area Under The Curve ◽

National Institutes Of Health ◽

Receiver Operating Curve ◽

Stroke Outcomes ◽

Braden Scale ◽

Grading Scale ◽

The Mean ◽

Clinical Grading

Abstract Background Prevention of pneumonia is critical for patients with acute ischemic stroke (AIS). The six indexes in the Braden Scale seemsto be related to the occurrence of pneumonia. We aimed to evaluate the feasibility of the Braden Scale in predicting the occurrence of pneumonia after AIS. Methods We studied a series of consecutive patients with AIS who were admitted to hospital. The cohort was subdivided into pneumonia group and no pneumonia group. The score of the Braden Scale, demographic and clinical characteristics at admission were obtained and analyzed by statistical comparisons between two groups. We investigated the predictive validity of the Braden scale by Receiver operating curve (ROC). Results 414 patients with AIS were included in this study. 57 of 414 (13.8%) patients fulfilled the criteria for post-stroke pneumonia. The National Institutes of Health Stroke Scale (NIHSS) score in the pneumonia group was significantly higher than in the no pneumonia group (P < 0.01). The mean score of the Braden Scale in the pneumonia group was significantly lower than that in the no pneumonia group (P < 0.01). The six subscales of the Braden Scale between the two groups all had significant differences. The area under the curve (AUC) for the Braden scale predicting pneumonia after acute ischemic was 0.883 (95% CI = 0.828-0.937). And with 18 points as the demarcation score, the sensitivity was 83.2% and the specificity was 84.2%. Conclusion The Braden Scale with 18 points as the demarcation score is a valid clinical grading scale for predicting pneumonia after AIS at presentation. Further studies on effect of Braden Scale on stroke outcomes are needed.

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The Association of CHA2DS2-VASc Score and Blood Biomarkers with Ischemic Stroke Outcomes: The Belgrade Stroke Study

PLoS ONE ◽

10.1371/journal.pone.0106439 ◽

2014 ◽

Vol 9 (9) ◽

pp. e106439 ◽

Cited By ~ 12

Author(s):

Tatjana S. Potpara ◽

Marija M. Polovina ◽

Dijana Djikic ◽

Jelena M. Marinkovic ◽

Nikola Kocev ◽

...

Keyword(s):

Ischemic Stroke ◽

Blood Biomarkers ◽

Stroke Outcomes ◽

Stroke Study

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Prognostic Value of Inflammatory and Cardiovascular Biomarkers for Prediction of 90-Day All-Cause Mortality after Acute Ischemic Stroke—Results from the Linz Stroke Unit Study

Clinical Chemistry ◽

10.1373/clinchem.2016.269969 ◽

2017 ◽

Vol 63 (6) ◽

pp. 1101-1109 ◽

Cited By ~ 15

Author(s):

Benjamin Dieplinger ◽

Christof Bocksrucker ◽

Margot Egger ◽

Christian Eggers ◽

Meinhard Haltmayer ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Stroke Unit ◽

Prognostic Value ◽

Prognostic Markers ◽

Stroke Severity ◽

Blood Biomarkers ◽

Amino Terminal ◽

All Cause Mortality

Abstract BACKGROUND Early outcome prediction after acute ischemic stroke is of great interest. The aim of our study was to evaluate the prognostic value of blood biomarkers in patients with acute ischemic stroke. METHODS We measured interleukin-6 (IL-6), d-dimer, amino-terminal pro–B-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T, and soluble ST2 plasma concentrations within 24 h after admission to our stroke unit in 721 consecutive acute ischemic stroke patients. End point was 90-day all-cause mortality. RESULTS During follow-up 81 patients died (11%). In univariate Cox proportional hazards regression analyses with the biochemical markers dichotomized according to median values, all baseline blood biomarkers were strong prognostic markers. However, in the multivariate analysis after adjustment for several clinical variables and the NIH Stroke Scale (NIHSS), only NIHSS >3 [risk ratio (RR) 7.87, 95% CI, 3.61–17.16; P < 0.001], IL-6 > 7 pg/mL (RR 4.09, 95% CI, 2.02–8.29; P < 0.001), and NT-proBNP >447 ng/L (RR 4.88, 95% CI, 2.41–9.88; P < 0.001) remained independent predictors. Using a simple multimarker approach combining these 3 complementary markers, we demonstrated that patients with increased NIHSS, IL-6, and NT-proBNP had the poorest outcome with a mortality rate of 38%, whereas no patient with negative readings for all 3 markers died during follow-up. CONCLUSIONS In this large cohort of patients with acute ischemic stroke, IL-6 and NT-proBNP at admission were strong and independent prognostic markers for 90-day all-cause mortality, and provided complementary prognostic information to the routinely used stroke severity score NIHSS.

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Association of admission leukocyte count with clinical outcomes in acute ischemic stroke patients undergoing intravenous thrombolysis with recombinant tissue plasminogen activator

Current Neurovascular Research ◽

10.2174/1567202617999201125201616 ◽

2020 ◽

Vol 17 ◽

Author(s):

Jie Chen ◽

Fu-Liang Zhang ◽

Shan Lv ◽

Hang Jin ◽

Yun Luo ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Plasminogen Activator ◽

Tissue Plasminogen Activator ◽

Leukocyte Count ◽

Intravenous Thrombolysis ◽

Recombinant Tissue Plasminogen Activator ◽

Functional Independence ◽

Tissue Plasminogen ◽

Poor Outcomes

Objective:: Increased leukocyte count are positively associated with poor outcomes and all-cause mortality in coronary heart disease, cancer, and ischemic stroke. The role of leukocyte count in acute ischemic stroke (AIS) remains important. We aimed to investigate the association between admission leukocyte count before thrombolysis with recombinant tissue plasminogen activator (rt-PA) and 3-month outcomes in AIS patients. Methods:: This retrospective study included consecutive AIS patients who received intravenous (IV) rt-PA within 4.5 h of symptom onset between January 2016 and December 2018. We assessed outcomes including short-term hemorrhagic transformation (HT), 3-month mortality, and functional independence (modified Rankin Scale [mRS] score of 0–2 or 0–1). Results:: Among 579 patients who received IV rt-PA, 77 (13.3%) exhibited HT at 24 h, 43 (7.4%) died within 3 months, and 211 (36.4%) exhibited functional independence (mRS score: 0–2). Multivariable logistic regression revealed admission leukocyte count as an independent predictor of good and excellent outcomes at 3 months. Each 1-point increase in admission leukocyte count increased the odds of poor outcomes at 3 months by 7.6% (mRS score: 3–6, odds ratio (OR): 1.076, 95% confidence interval (CI): 1.003–1.154, p=0.041) and 7.8% (mRS score: 2–6, OR: 1.078, 95% CI: 1.006–1.154, p=0.033). Multivariable regression analysis revealed no association between HT and 3-month mortality. Admission neutrophil and lymphocyte count were not associated with 3-month functional outcomes or 3-month mortality. Conclusion:: Lower admission leukocyte count independently predicts good and excellent outcomes at 3 months in AIS patients undergoing rt-PA treatment.

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Integrative physiological assessment of cerebral hemodynamics and metabolism in acute ischemic stroke

Journal of Cerebral Blood Flow & Metabolism ◽

10.1177/0271678x211033732 ◽

2021 ◽

pp. 0271678X2110337

Author(s):

Jui-Lin Fan ◽

Ricardo C Nogueira ◽

Patrice Brassard ◽

Caroline A Rickards ◽

Matthew Page ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Cerebral Autoregulation ◽

Cerebral Perfusion ◽

Prognostic Markers ◽

Important Determinant ◽

Stroke Care ◽

Contentious Issue ◽

Ischemic Tissue ◽

Physiological Assessment

Restoring perfusion to ischemic tissue is the primary goal of acute ischemic stroke care, yet only a small portion of patients receive reperfusion treatment. Since blood pressure (BP) is an important determinant of cerebral perfusion, effective BP management could facilitate reperfusion. But how BP should be managed in very early phase of ischemic stroke remains a contentious issue, due to the lack of clear evidence. Given the complex relationship between BP and cerebral blood flow (CBF)—termed cerebral autoregulation (CA)—bedside monitoring of cerebral perfusion and oxygenation could help guide BP management, thereby improve stroke patient outcome. The aim of INFOMATAS is to ‘ identify novel therapeutic targets for treatment and management in acute ischemic stroke’. In this review, we identify novel physiological parameters which could be used to guide BP management in acute stroke, and explore methodologies for monitoring them at the bedside. We outline the challenges in translating these potential prognostic markers into clinical use.

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Elevated Levels of Inflammation Markers Predict Poor Outcomes in Acute Ischemic Stroke Patients After Intravenous Thrombolysis

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2020.105587 ◽

2021 ◽

Vol 30 (3) ◽

pp. 105587

Author(s):

Dan Hu ◽

Caixia Ding ◽

Xuemei Jiang ◽

Jing Xiao ◽

Chuanyou Li ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Intravenous Thrombolysis ◽

Inflammation Markers ◽

Stroke Patients ◽

Poor Outcomes

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Comparison of Left Atrial Appendage Occlusion versus Non-Vitamin-K Antagonist Oral Anticoagulation in High-Risk Atrial Fibrillation: An Update

Journal of Cardiovascular Development and Disease ◽

10.3390/jcdd8060069 ◽

2021 ◽

Vol 8 (6) ◽

pp. 69

Author(s):

Shaojie Chen ◽

K. R. Julian Chun ◽

Zhiyu Ling ◽

Shaowen Liu ◽

Lin Zhu ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

High Risk ◽

Vitamin K ◽

Major Bleeding ◽

Left Atrial ◽

Left Atrial Appendage ◽

Vitamin K Antagonists ◽

Left Atrial Appendage Occlusion ◽

The Mean

Transcatheter left atrial appendage occlusion (LAAO) is non-inferior to vitamin K antagonists (VKAs) in preventing thromboembolic events in atrial fibrillation (AF). Non-vitamin K antagonists (NOACs) have an improved safety profile over VKAs; however, evidence regarding their effect on cardiovascular and neurological outcomes relative to LAAO is limited. Up-to-date randomized trials or propensity-score-matched data comparing LAAO vs. NOACs in high-risk patients with AF were pooled in our study. A total of 2849 AF patients (LAAO: 1368, NOACs: 1481, mean age: 75 ± 7.5 yrs, 63.5% male) were enrolled. The mean CHA2DS2-VASc score was 4.3 ± 1.7, and the mean HAS-BLED score was 3.4 ± 1.2. The baseline characteristics were comparable between the two groups. In the LAAO group, the success rate of device implantation was 98.8%. During a mean follow-up of 2 years, as compared with NOACs, LAAO was associated with a significant reduction of ISTH major bleeding (p = 0.0002). There were no significant differences in terms of ischemic stroke (p = 0.61), ischemic stroke/thromboembolism (p = 0.63), ISTH major and clinically relevant minor bleeding (p = 0.73), cardiovascular death (p = 0.63), and all-cause mortality (p = 0.71). There was a trend toward reduction of combined major cardiovascular and neurological endpoints in the LAAO group (OR: 0.84, 95% CI: 0.64–1.11, p = 0.12). In conclusion, for high-risk AF patients, LAAO is associated with a significant reduction of ISTH major bleeding without increased ischemic events, as compared to “contemporary NOACs”. The present data show the superior role of LAAO over NOACs among high-risk AF patients in terms of reduction of major bleeding; however, more randomized controlled trials are warranted.

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