Serum Occludin Level Combined With NIHSS Score Predicts Hemorrhage Transformation in Ischemic Stroke Patients With Reperfusion.

Shuhua Yuan,Ke Jian Liu,Huining Kang,Chengbei Hou,Weili Li,Zhifeng Qi,Qingfeng Ma,Xunming Ji

doi:10.3389/fncel.2021.714171

Abstract

Hemorrhagic transformation (HT) is a severe complication following acute ischemic stroke, particularly with reperfusion interventions, leading to poor prognosis. Serum occludin level is related with blood brain barrier disruption, and the National Institute of Health stroke scale (NIHSS) score reflects stroke severity. We investigated whether the two covariates are independently associated with HT and their combination can improve the accuracy of HT prediction in ischemic stroke patients with reperfusion therapy. Seventy-six patients were screened from the established database of acute ischemic stroke in our previous study, which contains all clinical information, including serum occludin levels, baseline NIHSS score, and hemorrhagic events. Multivariate logistic regression analysis showed that serum occludin level (OR = 4.969, 95% CI: 2.069–11.935, p < 0.001) and baseline NIHSS score (OR = 1.293, 95% CI 1.079–1.550, p = 0.005) were independent risk factors of HT after adjusting for potential confounders. Compared with non-HT patients, HT patients had higher baseline NIHSS score [12 (10.5–18.0) versus 6 (4–12), p = 0.003] and serum occludin level (5.47 ± 1.25 versus 3.81 ± 1.19, p < 0.001). Moreover, receiver operating characteristic curve based on leave-one-out cross-validation showed that the combination of serum occludin level and NIHSS score significantly improved the accuracy of predicting HT (0.919, 95% CI 0.857–0.982, p < 0.001). These findings suggest that the combination of two methods may provide a better tool for HT prediction in acute ischemic stroke patients with reperfusion therapy.

Highlights

Ischemic stroke accounts for 70–80% of all stroke patients, and reperfusion therapy has proved to be an effective treatment in patients with ischemic stroke (Wang et al, 2017; Campbell et al, 2019)
These results suggested that both serum occludin and National Institute of Health stroke scale (NIHSS) score were related with Hemorrhagic transformation (HT), but neither of them alone was good at predicting the HT or the subgroups of HT
We developed a combined model with two prediction variables, the baseline serum occludin level and the NIHSS score, to predict the probability of HT event in the stroke patients with reperfusion therapy

Summary

INTRODUCTION

Ischemic stroke accounts for 70–80% of all stroke patients, and reperfusion therapy has proved to be an effective treatment in patients with ischemic stroke (Wang et al, 2017; Campbell et al, 2019). We hypothesize that the combination of serum occludin level with other HT risk factors may further improve the predictive ability for HT in stroke patients with reperfusion therapy As it is well recognized, besides different treatment measures, there are many other risk factors associated with HT in clinic, such as age, ischemic severity, infarct size, hyperglycemia, and hypertension (Whiteley et al, 2012). Baseline clinical information for the enrolled patients already existed in our database, including age, sex, medical history, antithrombotic therapy before or after reperfusion, time from onset to blood sampling or reperfusion, baseline blood pressure, baseline NIHSS score, baseline serum occludin level, laboratory data, cranial CT scans, treatment methods, lesion location, and the site of artery occlusion

MATERIALS AND METHODS

RESULTS

DISCUSSION

CONCLUSION

ETHICS STATEMENT

Limitations of the Study