Marker In Acute Ischemic Stroke Research Articles

Role of Von Willebrand factor level as a biomarker in acute ischemic stroke

BackgroundVon Willebrand factor (VWF) is a large, multimeric glycoprotein that plays a role in thrombus formation; it is also an important mediator of inflammation. Our study aims to determine the association of VWF plasma level and acute ischemic stroke and determine plasma level of VWF in different subtypes of acute ischemic stroke. This case–control study was conducted on 90 subjects: 30 acute ischemic atherosclerotic stroke patients, 30 acute cardioembolic stroke patients and 30 healthy age and sex-matched control subjects. Stroke patients were recruited within the first week of stroke onset with an age range from 18 to 75 years. All subjects underwent complete neurological examination, duplex ultrasonography (U/S), CT brain, routine laboratory work-up and serum level of VWF.ResultsVWF serum levels were significantly elevated in patients of acute ischemic stroke, compared to control subjects. Higher plasma levels of VWF were observed in patients with acute ischemic atherosclerotic stroke.ConclusionSerum level of VWF can be used as a marker for acute ischemic stroke, especially the atherosclerotic subtype.

Serum Vitamin D Level as a Risk Factor and Prognostic Marker for Acute Ischemic Stroke: A Case-Control Study at a Tertiary Care Centre in Northern India.

Introduction Stroke is a predominant cause of death worldwide. Major risk factors for stroke in any age group are diabetes, hypertension, heart disease, smoking, and long-term alcohol abuse. It is of utmost importance to identify the risk factors for stroke to prevent recurrence. Vitamin D deficiency is identified as a risk factor for stroke. Therefore, we attempted to look for a correlation between vitamin D levels and acute ischemic stroke. Methods This observational case-control study was conducted with 150 patients (75 cases and 75 controls). On the day of admission, the National Institutes of Health Stroke Scale (NIHSS) score was calculated, and vitamin D levels were measured for each patient. The functional outcome was determined by the modified Rankin scale (mRS). Results The most common risk factors identified in this study were hypertension (61.3%), diabetes mellitus (41.3%), and smoking (37.3%). Out of 75 patients enrolled in the study, 49.4% had significant vitamin D deficiency, and 30.6% had insufficient vitamin D levels. Our study showed a significant correlation between vitamin D sufficiency in the body and the incidence of stroke (x2=3.888 and p=0.048). A significant correlation (p=0.03) was found between the NIHSS score and vitamin D levels in patients with acute ischemic stroke. Conclusion In this observational case-control study, we concluded that the increasing severity of vitamin D deficiency was associated with more deaths and poor outcomes.

Dynamic of Glycemic State as a Prognostic Marker in Acute Ischemic Stroke: A Prospective Controlled Cohort Observational Study

Abstract Background Hyperglycemia is encountered in 20% to 40% of acute stroke patients, with or without a pre-morbid diagnosis of diabetes mellitus. Hyperglycemia is a risk factor for infarct expansion and poor outcome through the first 72 hours of hospitalization in both diabetics and nondiabetics. Major and minor studies of stroke patients suggested that ‘Stress Hyperglycemia’ (raised blood glucose levels without a previous diagnosis of diabetes) was associated with a poorer outcome. Aim of the Work The aim of the work was to study the glycemic status after acute ischemic stroke and to assess the influence of glycemic status in the stroke outcome. Patients and Methods This study was a prospective cohort study conducted in Ain shams University Hospitals during the period from October 2019 to March 2020. The study included a total of 105 patients presented with acute ischemic stroke within 24 hours from onset of symptoms. The study population were predominantly males (60.95%), with a mean age of 61.66 ± 10.38 years (range from 40 to 85 years). Results Our study revealed that: Hyperglycemia is a good predictor of mortality outcome after acute ischemic stroke (65.7% vs. 5.7%), stress hyperglycemia had the worst mortality outcome compared with diabetic group and control group (85.7% vs. 45.7% vs. 5.7%; respectively), hyperglycemia is a good marker of stroke severity assessed by NIHSS score (14.60 ± 5.80 vs. 7.60 ± 3.38), hyperglycemia has significant association with longer ICU and hospital stay (12.26 ± 8.92 vs. 2.89 ± 4.07 days), NIHSS score is a significant predictor of mortality outcome after acute stroke (18.20 ± 3.43 vs. 7.30 ± 1.86), hyperglycemia has significant association with posterior circulation strokes (20% vs. 0.0%) and patients with hyperglycemia had higher incidence of intracerebral complications, namely hemorrhagic transformation (17.1%) and brain edema (10%). Conclusion This study revealed that there is an association between admission hyperglycemia and poor outcome after acute ischemic stroke. Admission hyperglycemia worsens the outcome and functional disability during the phase of ischemic stroke. Hyperglycemia at stroke onset, without prior history of DM have particularly poor prognosis, than those with hyperglycemia in known diabetes.

Single Serum Cortisol Value as a Prognostic Marker in Acute Ischemic Stroke.

Stroke is a major global burden with significant morbidity, mortality, and long-term disability. Acute ischemic stroke (AIS) is a stressful condition causing stimulation of the hypothalamic-pituitary-adrenal (HPA) axis resulting in numerous endocrinal alterations in the body. We evaluated the serum cortisol as a prognostic marker in AIS. This was a prospective observational study comprising 100 cases suffering from AIS, and serum cortisol at the baseline was measured. Severity was evaluated using the National Institutes of Health Stroke Scale (NIHSS) during admission, and functional outcome was assessed at 1, 4, and 24 weeks using a modified Rankins score (mRS). Statistical analysis was performed to find the relationship between serum cortisol and the severity of stroke, outcome, and mortality at 1, 4, and 24 weeks of stroke. In our study, we found positive correlations between random blood sugarand serum cortisol (r = 0.273, p = 0.006); stroke severity (NIHSS) and serum cortisol (r = 0.785, p< 0.001); stroke outcome (mRS) at 1, 4, and 24 weeks; and serum cortisol (p < 0.001 and r = 0.676, 0.654, 0.650 for all three intervals, respectively). We also found higher serum cortisol among patients who died at 1, 4, and 24 weeks compared to those who survived with a p-value being <0.001 for all three intervals. A stress response causing an increase in serum cortisol occurs in AIS. This response is detrimental to the patient. The serum cortisol at baseline can be considered a marker of severity, short- and long-term prognosis, and mortality after AIS.

Impacts of eosinophil percentage on prognosis acute type A aortic dissection patients

BackgroundEosinophils are pro-inflammatory cells involved in thrombosis and have been proposed as a prognosis marker in acute ischemic stroke and ST-elevation myocardial Infarction. Here, we sought to clarify the prognostic value of eosinophil percentage (EOS%) in patients with acute type A aortic dissection (AAAD).MethodsWe examined 183 consecutive AAAD patients. Based on the optimum cut-off value of EOS% determined by X-tile software, patients were classified into the low EOS% (EOS% ≤ 0.1) and high EOS% groups (EOS% > 0.1). We performed multivariate regression analysis and Kaplan–Meier (KM) survival curves to assess the association between EOS% and mortality. Eosinophil accumulation in aortic dissection intraluminal thrombus was confirmed using hematoxylin–eosin (H&E) staining. An external cohort from Medical Information Mart for Intensive Care IV was performed to validate the results.ResultsRelative to surviving patients, those who died during hospitalization had significantly lower EOS% (p = 0.001) but significantly higher WBC (p = 0.002) and neutrophil (p = 0.001) counts. Multivariate regression analysis identified EOS% as an independent predictor of in-hospital and 1-year mortality. KM curves revealed that 1-year cumulative mortality was significantly higher in the low EOS% group, although it was mainly attributed to the higher 30-day mortality. H&E staining revealed massive infiltration of eosinophils in all 20 thrombus specimens. The external validation confirmed that relative to survivors, patients with in-hospital mortality (p = 0.010) had significantly lower EOS%. Moreover, multivariate regression analyses identified that decreased EOS% was independently significantly associated with in-hospital mortality.ConclusionsLow EOS% is significantly related to increased mortality rates in AAAD patients.

Increased Platelet-to-Lymphocyte Ratio is an Independent Predictor of Hemorrhagic Transformation and In-Hospital Mortality Among Acute Ischemic Stroke with Large-Artery Atherosclerosis Patients.

BackgroundThe platelet-to-lymphocyte ratio (PLR) is an inflammation marker of acute ischemic stroke, but its significance in patients with hemorrhage transformation (HT) after acute ischemic stroke with large-artery atherosclerosis (AIS-LAA) is unclear, and we also identified the relationship between PLR and in-hospital mortality of HT after AIS-LAA.MethodsThis was a retrospective analysis of patients with AIS-LAA. The PLR was calculated according to platelet and lymphocyte counts on admission. HT was defined on follow-up magnetic resonance imaging or computed tomography when neurologic deterioration worsened during hospitalization. The univariate analysis and multivariate logistic regression were performed to assess the association of PLR, HT and in-hospital mortality of HT after AIS-LAA.ResultsWe included 328 Chinese AIS-LAA patients (mean age 67.2±11.1 years; 70.4% male). HT occurred in 38 patients (11.6%). After multivariate regression analyses, NRL (odds ratio [OR] 1.354, 95% confidence interval [CI] 1.176–1.559, P<0.001) and PLR (odds ratio [OR] 3.869, 95% confidence interval [CI] 2.233–5.702, P<0.001) were independently associated with HT after AIS-LAA. The area under the ROC curve (AUC) value of PLR (0.72, 95% CI (0.64–0.80), P<0.001) tested a greater discriminatory ability compared with neutrophil-lymphocyte ratio (NLR) (0.67, 95% CI (0.58–0.76), P<0.001). Meanwhile, PLR was found to be significantly related to HT after AIS-LAA, including in subtypes of artery-to-artery embolization (aOR 1.699, 95% CI 1.298–3.215, P<0.001), in-situ thrombosis (aOR4.499, 95% CI 1.344–9.054, P<0.001) and branch atheromatous disease (aOR3.239, 95% CI 1.098–8.354, P<0.001). Increased PLR predicts high in-hospital mortality of HT after AIS-LAA (OR 1.041, 95% CI (1.006–1.077), P=0.020; aOR 1.053, 95% CI (1.004–1.104), P=0.034).ConclusionHigh PLR is associated with greater risk of HT in AIS-LAA patients, including in artery-to-artery embolization, in-situ thrombosis and branch atheromatous disease. Meanwhile, increased PLR predicts high in-hospital mortality of HT after AIS-LAA.

Early Neutrophil-to-Lymphocyte Ratio Is a Prognostic Marker in Acute Ischemic Stroke After Successful Revascularization

To explore the association between early neutrophil-to-lymphocyte ratio (ENLR) and prognosis of anterior circulation large-vessel occlusion stroke (LVOS) after patients undergo endovascular treatment (EVT) with successful revascularization. Patients who experienced acute anterior circulation LVOS and underwent EVT at Changzhou Second People's Hospital Affiliated to Nanjing Medical University between May 2017 and May 2020 were included in this retrospective study. We collected information about patients' baseline characteristics, medical history, laboratory test results, imaging data, and endovascular treatment outcomes, as well as data from follow-up at 3 months. Univariate and multivariate logistic regression models were used to evaluate the association between ENLR and functional disease prognosis. A piecewise linear regression model was also applied to compute the threshold effect of ENLR on poor prognosis (defined as modified Rankin Scale score 3-6) at 3 months using a smoothing plot. Of 224 patients who received EVT during the study period, 160 patients were included in the analysis. After adjustments were made for potential confounders, multivariate analysis demonstrated a significant association between ENLR and poor prognosis at 3 months (odds radio 1.19; 95% confidence interval 1.07-1.32; P= 0.0016). An ENLR ≥9.75 was found to be significantly associated with poor prognosis at 3 months (odds ratio 1.54; 95% confidence interval 1.19-2.00; P= 0.0119). Increased ENLR after successful revascularization is independently associated with poor prognosis. These findings suggest that ENLR could be used to inform treatment strategies for patients who experience anterior circulation LVOS.

Eosinophil-to-Neutrophil Ratio Predicts Poor Prognosis of Acute Ischemic Stroke Patients Treated With Intravenous Thrombolysis.

Background and Purpose: The eosinophil-to-neutrophil ratio (ENR) was recently reported as a novel inflammatory marker in acute ischemic stroke (AIS). However, few studies reported the predictive value of ENR in AIS patients, especially for those with intravenous thrombolysis.Methods: Two hundred sixty-six AIS patients receiving intravenous thrombolysis were retrospectively recruited in this study and followed up for 3 months and 1 year. The Modified Rankin Scale (mRS) and the time of death were recorded. Poor outcome was defined as mRS 3–6. After excluding patients who were lost to follow-up, the remaining 250 patients were included in the 3-month prognosis analysis and the remaining 223 patients were included in the 1-year prognosis analysis.Results: ENR levels in the patients were lower than those in the healthy controls. The optimal cutoff values for the ability of ENR × 102 to predict 3-month poor outcome were 0.74 with 67.8% sensitivity and 77.3% specificity. Patients with ENR × 102 ≥ 0.74 have a lower baseline National Institutes of Health Stroke Scale (NIHSS) score (median: 7 vs. 11, p < 0.001). After multivariate adjustment, patients with ENR × 102 ≥ 0.74 were more likely to come to a better 3-month outcome (OR = 0.163; 95% CI, 0.076–0.348, p < 0.001). At the 1-year follow-up, the patients with ENR × 102 ≥ 0.74 showed a lower risk of mortality (HR = 0.314; 95% CI, 0.135–0.731; p = 0.007).Conclusions: A lower ENR is independently associated with a 3-month poor outcome and a 3-month and 1-year mortality in AIS patients treated with intravenous thrombolysis.

GLOS and HARM in patients with transient neurovascular symptoms with and without ischemic infarction

Background and purposeGadolinium leakage in ocular structures (GLOS) on fluid attenuated inversion recovery images (FLAIR) is a novel imaging marker in acute ischemic stroke and other neurological disorders. MethodsIn patients with transient neurovascular symptoms who underwent repeated MRI with intravenous contrast agent administration, the presence of acute ischemic lesions on diffusion-weighted images (DWI) as well as the frequency and pattern of blood-brain barrier and blood-retina barrier impairment as demonstrated by the hyperintense acute reperfusion marker (HARM) and GLOS respectively on postcontrast FLAIR were evaluated. ResultsOverall 28 patients with transient neurovascular symptoms (median age 70.5 years; 18 (64.3%) male) were included. Follow-up MRI was performed within 35 (IQR 21–47) hours after the initial MRI. On DWI, acute ischemic lesions were observed in 22 (78.6%). On contrast-enhanced FLAIR, GLOS was observed in 12 (42.9%) patients: in 1 (3.6%) only in the anterior chamber, and in 11 (39.3%) in the anterior chamber and vitreous body. HARM was observed in 3 (10.7%) patients. In one patient without ischemic lesion on DWI or HARM on FLAIR, GLOS was observed in the anterior chamber and vitreous body. Presence of GLOS was associated with higher age (p = 0.04) and detection of HARM (p = 0.03). ConclusionsIn patients with transient neurovascular symptoms, GLOS is a frequent finding and associated with HARM on contrast-enhanced FLAIR. As GLOS was observed in one patient without an ischemic lesion or HARM, it might be useful as an additional imaging marker.

Intraluminal Thrombus and Outcomes of Patients With Acute Large Vessel Occlusive Stroke Undergoing Endovascular Treatment.

Intraluminal thrombus (ILT) is an emerging imaging marker in acute ischemic stroke. We aimed to investigate the association of ILT with outcomes of acute large vessel occlusion (LVO) patients receiving endovascular treatment. Acute LVO stroke patients who underwent endovascular treatment within 24 hours, in a prospective, nationwide registry were enrolled. Pretreatment digital subtraction angiography was reviewed for the presence of ILT. The primary outcome was 90-day functional dependence (modified Rankin Scale scores, 3-6). Secondary outcomes included 24-hour LVO, 90-day death, and symptomatic intracranial hemorrhage. Among 711 patients enrolled, 75 (10.5%) with ILT were less likely to have 90-day functional dependence compared with those without ILT (adjusted odds ratio, 0.53 [95% CI, 0.31-0.90]; P=0.021). The same trend was found among those with successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b-3; P=0.008) but not in those without successful reperfusion (P=0.107). Presence of ILT was also independently associated with a lower rate of 24-hour LVO (adjusted odds ratio 0.34 [95% CI, 0.13-0.89]; P=0.028). However, those with or without ILT had similar risks of symptomatic intracranial hemorrhage and 90-day death. Among acute LVO patients receiving endovascular treatment, pretreatment ILT-positive patients may have a better 90-day functional outcome (versus ILT-negative) but similar risk of death and symptomatic intracranial hemorrhage. The possibly favorable effect of ILT patients remained in those with successful reperfusion. Registration: URL: http://www.chictr.org.cn; Unique identifier: ChiCTR1900022154.

Neutrophil Lymphocyte Ratio as a Prognostic Marker in Acute Ischemic Stroke: a Systematic Review and Meta-analysis.

Acute ischemic stroke leads to an inflammatory response and the neutrophil-to-lymphocyte ratio is an inflammatory indicator for determining prognosis in acute ischemic stroke. This meta-analysis aims to show evidence that neutrophil-to-lymphocyte can act as an independent and early prognostic marker in cases of acute ischemic stroke. Databases of PubMed, and Embase were searched for literature. Relevant data were extracted by SSP and BT from eligible literature. Odds ratios with 95% confidence intervals were pooled and a Forest plot was used to evaluate the prognostic value of neutrophil-to-lymphocyte in acute ischemic stroke. Modified Rankin Scale ? 3 was defined as a poor functional outcome. A funnel plot is used to show the symmetric distribution and no publication bias. According to Joanna Briggs Institute assessment for analytical observational studies, the studies included are of fair to good quality. Eight relevant studies with 3011 patients were included, one with no data on OR. The pooled OR of 6 studies with the poor functional outcome at 3 months was 1.47(P<0.02 95%CI: 1.40-2.31) while one study with the poor functional outcome at discharge was OR=2.49. In patients with acute ischemic stroke, elevated neutrophil-to-lymphocyte correlates with poorer functional outcome and increased chances of developing symptomatic Intracranial Hemorrhage. Baseline neutrophil-to-lymphocyte can be an inexpensive and easily available biomarker, especially in resource-poor settings, for predicting clinical outcomes in patients with ischemic stroke.

Study of Serum Calcium as a Prognostic Marker in Acute Ischemic Stroke

Study of Serum Calcium as a Prognostic Marker in Acute Ischemic Stroke

Admission Blood Pressure As a Prognostic Marker in Acute Ischemic Stroke

Admission Blood Pressure As a Prognostic Marker in Acute Ischemic Stroke

Role of serum ferritin as a prognostic marker in acute ischemic stroke: A preliminary observation.

Background:Acute ischemic stroke is an important cause of morbidity and mortality. Search has been on to find out the factors which can help in formulating the prognosis of acute ischemic stroke. One of the prognostic indicators, which has gained great clinical interest in recent times, is serum ferritin.Aims:To assess the serum ferritin levels in patients with acute ischemic stroke and to study the role of serum ferritin as a prognostic marker in these patients.Materials and Methods:This prospective, observational study was conducted on 50 patients of acute ischemic stroke aged ≥18 years who presented within 48 hours of onset of symptoms. Clinical severity of stroke was assessed at admission and on the 6th day using Canadian Stroke Scale (CSS), and serum ferritin levels were measured at admission and on the 6th day in all these subjects.Results:The mean serum ferritin levels at admission in patients with “more severe stroke” (CSS score at admission ≤7) and “less severe stroke” (CSS score at admission >7) were 282.77 ± 120.53 and 205.12 ± 110.96 ng/mL, respectively. The mean serum ferritin levels at admission were 173.71 ± 109.69 ng/mL in subjects who did not deteriorate and 336.86 ± 57.28 ng/mL in those who deteriorated, while the mean serum ferritin levels on the 6th day were 193.29 ± 101.88 and 343.95 ± 52.34 ng/mL in subjects who did not deteriorate and those who deteriorated, respectively.Conclusions:Serum ferritin has a significant positive correlation with the severity of acute ischemic stroke (P < 0.001), and the levels correlate with the outcome of the disease (P < 0.001); the patients with higher serum ferritin at admission tend to deteriorate more as compared to those with lower levels. Thus, serum ferritin can be used as a prognostic marker in acute ischemic stroke.

Study of microalbuminuria in acute ischemic stroke and its correlation with severity

Introduction: With the rising incidence of noncommunicable diseases such as stroke in low- and medium-income countries like India, it has become imperative to identify the potentially modifiable risk factors and focus on prevention. Microalbuminuria (MA) is now gaining recognition as an independent risk factor for ischemic stroke. It has also been studied as a prognostic marker for acute ischemic stroke. Thus, it was intended to study MA in acute ischemic stroke and its correlation with stroke severity. Methods: A single-center case–control study was done after enrolling seventy cases of ischemic stroke with age between 40 and 65 years, satisfying inclusion and exclusion criteria during a span of 2 years. Fifty patients in the age group of 40–65 years with no history of stroke and transient ischemic attack and fulfilling the exclusion criteria were taken as control. All cases were subjected to detailed history, systemic clinical examination, and biochemical and radiological investigations with assessment of National Institutes of Health Stroke Scale (NIHSS) for grading of severity of ischemic stroke with semi-quantitative measurement of MA (urinary albumin: creatinine ratio). Results: Hypertension (62.86%), diabetes mellitus (34.29%), and smoking (27.14%) were found to be the major risk factors for acute ischemic stroke. MA was present in 48.57% of cases, whereas in the control group, MA was present only in 18% of patients. Our study showed MA as an independent risk factor for acute ischemic stroke. On multivariate logistic regression analysis of risk factors of acute ischemic stroke, odd ratio for MA was 4.312 with P = 0.005. In our study, cases with mean NIHSS 17.71 and median NIHSS 18 were positive for MA, while cases with mean NIHSS 13.03 and median NIHSS 12 were negative for MA, that is, cases with higher mean and median NIHSS were positive for MA. This association of MA with NIHSS was statistically significant (P = 0.036). Conclusion: MA was found in approximately half of the patients studied with acute ischemic stroke, and there was a significant association between MA and higher NIHSS.

Investigation of the Value of T peak to T end and QTc Intervals as Electrocardiographic Arrhythmia Susceptibility Markers in Acute Ischemic Stroke.

Arrhythmias are one of the most common causes of mortality in patients with acute ischemic stroke (AIS). This study aimed to investigate the relationships of arrhythmia susceptibility markers (QT, QTc, Tpe, Tpe-D, Tpe/QT, and Tpe/QTc) with the localization and volume of the ischemic area, the National Institutes of Health Stroke Scale (NIHSS) scores, and troponin levels in AIS. Patients diagnosed with AIS in the emergency department in the period from 01 November 2016 to 31 March 2019 were retrospectively reviewed. Patients admitted to the emergency department with no pathological ECG findings were included. The measurements of QT, QTc, Tpe, Tpe-D, Tpe/QTc, and Tpe/QT were performed under a digital microscope. The NIHSS scores, troponin values, and the ischemic area volume based on the diffusion-weighted magnetic resonance imaging findings at the time of admission were found. A total of 135 patients, comprising 70 AIS patients and 65 individuals as controls, were included in the study. The male/female ratio was 73/62 and the mean age was 68.51±10.80 years. All of the ECG parameters in the AIS group and the control group were statistically significantly different between the groups except Tpe-D (p=0.454) (For QT, QTc, Tpe, Tpe/QTc, and Tpe/QT; p=0.003, 0.022, <0.001, 0.001, 0.001; respectively). QT, QTc, Tpe, Tpe/QTc, and Tpe/QT values were not significantly different between the groups with a NIHSS score of ≤5 and >5 (p=0.480, 0.688, 0.663, 0.512, 0.333, respectively). Arrhythmia susceptibility markers including QT, QTc, Tpe, the values of Tpe-D, Tpe/QT, and Tpe/QTc are different in AIS patients compared to the individuals in the control group; therefore, these parameters can be included among the other parameters of close cardiac monitoring.

Clinical Usefulness of Cell-Free DNA as a Prognostic Marker in Acute Ischemic Stroke

Stroke has become the second most common cause of death. Several biomarkers have been detected in the peripheral blood from stroke patients, but none has found a place in clinical practice. Cell-free DNA (cf-DNA) liberated into the blood soon after the onset of stroke might be useful for assessing disease severity and prognosis. A total of 54 patients presenting with ischemic stroke were recruited consecutively with the exclusion of patients having trauma, tumor, infections, and organ failure. The cf-DNA was extracted by circulating nucleic acid kit from Qiagen and measured by real-time quantitative polymerase chain reaction assay for β-globin gene. The primary outcome measure was poststroke modified Rankin scale Score at 3 months after the onset of symptoms. Higher cf-DNA levels were associated with severity at the time of admission measured by National Institutes of Health Stroke Scale (P=0.003) and poor outcome as measured by modified Rankin scale 3-month scores (P=0.001). Therapeutic intervention in the form of a mechanical thrombectomy or IV thrombolysis was associated with improved outcome in patients with cf-DNA<10,000 kilogenome-equivalents/L (P≤0.01). cf-DNA level correlates well with the severity of stroke at admission and long-term prognosis. It can be used as an additional marker to predict the outcome of therapeutic intervention.

Inflammatory markers in acute ischemic stroke with and without preexisting major depression: Methodological issues.

Inflammatory markers in acute ischemic stroke with and without preexisting major depression: Methodological issues.

Prognostic value of copeptin in patients with aneurysmal subarachnoid hemorrhage

BackgroundRecently, copeptin has been identified as a plasma prognosis marker in acute ischemic stroke and intracerebral hemorrhage (ICH). This study investigated the prognostic value of copeptin in the patients with aneurysmal subarachnoid hemorrhage(aSAH). MethodsIn this retrospective study, 243 consecutive patients were included. Upon admission, plasma copeptin levels were measured by enzyme-linked immunosorbent assay. The end points were mortality and poor functional outcome (Glasgow Outcome Scale score of 1–3) after 3 months. ResultsIn 243 patients, 112 (46.1%) were male and median age was 58 years (IQR 49–68). Median copeptin plasma levels were 21.0 pmol/l (IQR 13.2–31.2). Copeptin levels increased with increasing severity of aSAH as defined by the World Federation of Neurological Surgeons (WFNS) score. Patients with a poor outcome and nonsurvivors had significantly increased copeptin levels on admission (P < .001 both). In the multivariate analysis, for each 1 pmol/l increase of plasma concentration of copeptin, the adjusted risk of poor outcomes and mortality would be increased by and 6% (1.06 [1.02–1.10], P < .001) and 9% (1.09 [1.03–1.13], P < .001), respectively. Receiver operating characteristics to predict functional outcome and mortality demonstrated areas under the curve of copeptin of 0.74 (95% confidence interval [CI], 0.67–0.81) and 0.81 (95% CI, 0.74–0.87), which was comparable with the WFNS score(P > .05) but superior to C-reactive protein and IL-6 (P < .01). ConclusionsThe data shows that copeptin levels may reliably predict short-term prognosis at its onset in aSAH patients.

Clinical usefulness of brain-derived neurotrophic factor and visinin-like protein-1 in early diagnostic tests for acute stroke

ObjectivesLack of a rapid biochemical test for acute stroke is a limitation in the diagnosis and management of acute stroke. The aim of this study is to evaluate the efficacy of BDNF and VILIP-1 as diagnostic markers in acute ischemic stroke and as predictors of mortality. MethodsThe study included 75 patients with acute ischemic stroke older than 18 years. During the same period, 28 normal controls were recruited from the hospital ED. Blood samples were collected from all patients at admission to determine the levels of VILIP-1 and BDNF. ResultsThe mean VILIP-1 levels in the study and control groups were 0.547 ± 0.081 and 0.515 ± 0.035 ng/mL, respectively, and the difference was not significant (p = 0.071). The mean BDNF levels in the study and control groups were 3.89 ± 2.05 ng/mL and 14.9 ± 4.7 ng/mL, respectively, and the level was significantly (p < 0.0001) lower in the stroke patients. ConclusionThe BDNF level showed a significant ability to discriminate stroke and control patients but did not predict mortality. The VILIP-1 level showed insignificant ability to discriminate stroke patients and again did not predict mortality.