Abstract
BackgroundHigher circulating levels of tissue inhibitor of matrix metalloproteinases (TIMP)-1 early after ischemic stroke have been associated with lower survival. The objectives of this study were to determine serum TIMP-1 levels during the first week of a severe cerebral infarction in surviving and non-surviving patients, and whether those levels during the first week could be used as a mortality biomarker for these patients.MethodsWe included patients with severe malignant middle cerebral artery infarction (MMCAI) defined as computer tomography showing ischaemic changes in more than 50% of the middle cerebral artery territory and Glasgow Coma Scale (GCS) ≤ 8. We measured serum levels of matrix metalloproteinases (MMP)-9 and TIMP-1. End-point study was 30-day mortality.ResultsWe found higher TIMP-1 concentrations at days 1 (p < 0.001), 4 (p = 0.001), and 8 (p = 0.03) of MMCAI in non- urviving (n = 34) than in surviving (n = 34) patients. We found lower serum MMP-9 concentrations at day 1 (p = 0.03) of MMCAI and no significant differences at days 4 and 8. ROC curve analysis of TIMP-1 concentrations performed at days 1, 4, and 8 of MMCAI showed an area under curve to predict 30-day mortality of 81% (p < 0.001), 80% (p < 0.001) and 72% (p = 0.07) respectively.ConclusionsThe new findings of our study were that non-surviving MMCAI patients showed higher serum TIMP-1 levels during the first week of MMCAI that surviving patients, and those levels during the first week of MMCAI could be used as mortality biomarkers.
Highlights
Higher circulating levels of tissue inhibitor of matrix metalloproteinases (TIMP)-1 early after ischemic stroke have been associated with lower survival
We considered that patients showed a severe malignant middle cerebral artery infarction (MMCAI) when the findings of computer tomography showed ischaemic changes in more than 50% of the middle cerebral artery territory and patients showed an acute neurological deterioration consisting of a Glasgow Coma Scale (GCS) [27]≤8
We found higher serum TIMP-1 concentrations at days 1 (p < 0.001), 4 (p = 0.001), and 8 (p = 0.03) of MMCAI in non-surviving than in the surviving patient group (Table 2 and Fig. 1)
Summary
Higher circulating levels of tissue inhibitor of matrix metalloproteinases (TIMP)-1 early after ischemic stroke have been associated with lower survival. Higher circulating TIMP-1 levels at day 1 of ischemic stroke have been associated with poor neurological outcome [24, 25] and lower survival [26]. The objectives of this study were to compare serum TIMP-1 levels during the first week of a severe cerebral infarction between non-surviving and surviving patients and to determine whether those levels during the first week of a severe cerebral infarction could be used as a biomarker of early mortality
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