Severity Of Acute Ischemic Stroke Research Articles

Association of Serum Calcium With Infarct Size and Severity in Acute Ischemic Stroke: A Rural Hospital-Based Cross-Sectional Study.

Background One of the major mediators of ischemic neuronal cell death is calcium. It has been found that elevated serum calcium is associated with a better prognosis in patients with ischemic stroke. This study highlights the association of serum calcium, albumin-corrected calcium, and ionic calcium with the size of acute ischemic stroke as well as severity outcome in terms of the National Institutes of Health Stroke Scale (NIHSS) score and Barthel Index. Methods This cross-sectional study was conducted on 85 cases of acute ischemic stroke (based on a computerized tomography scan of the brain) from September 2019 to October 2021. All included patients had undergone complete clinical history, systemic examination, as well as estimation of serum total calcium, albumin corrected calcium, and ionic calcium.NIHSS score and Barthel Index were used to access the severity of each subject. Results A significant positive correlation was seen between infarct size with NIHSS with a correlation coefficient of 0.35. A significant negative correlation was seen between infarct size with serum calcium, albumin-corrected calcium, and Barthel Index with a correlation coefficient of -0.483, -0.354, and -0.365 respectively. No correlation was seen between infarct size and ionic calcium with a correlation coefficient of 0.082. Conclusion It can be concluded that higher normal levels of serum calcium and albumin-corrected calcium are associated with a smaller-sized infarct and had less severity index among patients with acute ischemic stroke.

Preliminary experience of CT imaging of the ischaemic brain penumbra through spectral processing of multiphasic CTA datasets

To assess ischaemic penumbra through the post-processing of the spectral multiphasic CT Angiography (mCTA) data in acute ischaemic stroke (AIS) patients. Thirty one consecutive patients strongly suspected of severe Middle Cerebral Artery AIS presenting less than 6 h after onset of symptoms or with unknown time of onset of symptoms underwent a standardized CT protocol in spectral mode including Non Contrast CT, mCTA, and Perfusion CT (CTP) on a dual-layer MDCT system. Areas disclosing delayed enhancement on iodine density (ID) maps were highlighted by subtraction of the serial mCTA datasets. Two neuroradiologists independently rated the correspondence between delayed enhancing areas at mCTA and the penumbral/infarcted areas delineated by two validated CTP applications using a 5-levels scoring scale. Interobserver agreement between observers was evaluated by kappa statistics. Dose delivery was recorded for each acquisition. Averaged correspondence score between penumbra delineation using subtracted mCTA-derived ID maps and CTP ones was 2.76 for one application and 2.9 for the other with best interobserver agreement kappa value at 0.59. All 6 stroke mimics out of the 31 patients’ cohort were correctly identified. Average dose delivery was 7.55 mSv for the whole procedure of which CTP accounted for 39.7%. Post-processing of spectral mCTA data could allow clinically relevant assessment of the presence or absence of ischaemic penumbra in AIS-suspected patients if results of this proof-of-concept study should be confirmed in larger patients’series.

Serum cold-inducible RNA-binding protein (CIRP) levels as a prognostic indicator in patients with acute ischemic stroke.

Acute ischemic stroke (AIS) is the leading cause of morbidity and mortality among cerebrovascular diseases. While animal studies have suggested a correlation between cold-inducible RNA-binding protein (CIRP) serum levels and the severity and prognosis of cerebral infarction, there has been a lack of research exploring this association in humans with cerebral infarction. A total of 148 patients diagnosed with AIS within 7 days from symptom onset were included in this study. Comprehensive information regarding the patients' basic demographics, medical history, clinical parameters, the severity of cerebral infarction, and serum CIRP levels was collected. Follow-up data were obtained through telephonic interviews or by reviewing clinical notes for 3 months after the patients were discharged to assess the functional outcomes of treatment. The findings of this study demonstrated a significant increase in serum CIRP levels during the early stages of AIS, followed by a gradual decline after 3 days. Significant differences were observed in the serum CIRP levels between the 1-day group and the 4-7 day group (P < 0.0047), as well as between the 2-3 day group and the 4-7 day group (P < 0.0006). Moreover, a significant positive correlation was observed between the serum CIRP levels and the severity of cerebral infarction. Higher serum CIRP levels were associated with more severe National Institutes of Health Stroke Scale scores (P < 0.05) and larger cerebral infarction volumes (P < 0.05). Furthermore, patients with higher serum CIRP levels exhibited poorer modified Rankin scale scores (P < 0.05). These findings indicate that serum CIRP serves as an essential pro-inflammatory mediator and a valuable biomarker for assessing brain injury in patients with AIS. The findings of this study suggest an elevation in serum CIRP levels among patients with AIS. These levels are positively correlated with the severity of AIS and serve as indicators of a poor prognosis. Therefore, CIRP could serve as a target for early clinical intervention while managing AIS, and further research should explore serum CIRP levels as prognostic indicators in AIS.

Association of Admission Anaemia with the Severity of Acute Ischemic Stroke: A Study in a Tertiary Care Hospital

Background: Acute ischemic stroke imposes substantial disability, economic, and social burdens. Prevention plays a vital role in reducing morbidity and mortality. Reduced hemoglobin concentration in ischemic stroke patients hampers oxygen delivery to neuronal tissue, leading to adverse effects on the ischemic penumbra and increasing the risk of infarct expansion. By addressing anemia and identifying other associated risk factors, we can effectively enhance stroke prevention strategies and mitigate its overall impact on individuals and society. Understanding the multifaceted nature of ischemic stroke and implementing comprehensive prevention measures is key to minimizing its devastating consequences. Objectives: The purpose of this study is to show the association of admission anaemia with the Severity of Acute Ischemic Stroke. Method and Materials: This cross-sectional study was carried out in the Department of Neurology, Dhaka Medical College and Hospital (DMCH), Dhaka for a period of two years. Two hundred and seventy- nine patients with acute ischemic stroke were selected consecutively through screening with a set of inclusion and exclusion criteria. Each patient underwent a CT of the head and/or MRI of the brain and blood tests, including hemoglobin (Hb) concentration on the first day of hospitalization. Demographic and risk factors from all subjects were collected with a structured questionnaire. The neurological state of the patients was assessed on the first day of hospitalization by the National Institute of Health Stroke Scale (NIHSS). After data collection analysis was done by SPSS for Windows version 26. A p-value ≤ 0.05 was considered statistically significant. Results: The frequency of anemia in acute ischemic stroke patients was 39.1%, in males it was 35.8%, and in females 44.7%. Frequency Anemia was observed more among the older patients than younger patients but there was no significant difference. Anemia was found highest in the age group ........

Neutrophil to high-density lipoprotein cholesterol ratio, a novel risk factor associated with acute ischemic stroke.

To investigate the relationship between neutrophil to high-density lipoprotein cholesterol ratio (NHR) and Acute Ischemic Stroke (AIS), and provide a new direction for the diagnosis and prevention of AIS. A total of 158 patients with AIS and 162 healthy individuals were recruited. Demographic, clinical, and laboratory data of participants were obtained and the multivariable logistic regression analysis was employed to assess risk factors for AIS. The receiver operating characteristic (ROC) curve was plotted to analyze the diagnostic value of NHR for AIS. The spearman correlation analysis was used to estimate the correlation between NHR and national institute of health stroke scale (NIHSS) score. The age, White blood cell, MONO (monocyte), NEUT (neutrophil), creatinine, TG (triglyceride), NHR, neutrophil to lymphocyte ratio and MONO to high-density lipoprotein cholesterol ratio were remarkably greater and HDL-C (high-density lipoprotein cholesterol) was dramatically lower in the case group compared with in the control group (P < .05). The multivariable logistic regression analysis revealed that age [OR = 1.095, 95% CI (1.056, 1.135)], TG [OR = 6.188, 95% CI (2.900, 13.206)] and NHR [OR = 11.394, 95% CI (1.196, 108.585)] were independent risk factors for AIS (P < .05). The areas under the curve (AUCs) for the prediction of AIS by the age, TG and NHR were 0.694, 0.686, 0.782, respectively, the specificity were 56.8%, 88.3%, 87.0%, and the sensitivity were 75.3%, 44.3%, 56.3%, respectively (P < .05). In addition, spearman correlation analysis indicated that there was a positive correlation between NHR and NIHSS score (R = 0.558, P < .05). The level of NHR was higher in patients with a NIHSS score of above 5 points compared with those with a NIHSS score of 5 points or lower (P < .0001). The age, TG, and NHR were independent risk factors for AIS, and the level of NHR was positively correlated with severity of AIS.

Cerebrospinal Fluid Biomarkers for Diagnosis and the Prognostication of Acute Ischemic Stroke: A Systematic Review.

Despite the high incidence and burden of stroke, biological biomarkers are not used routinely in clinical practice to diagnose, determine progression, or prognosticate outcomes of acute ischemic stroke (AIS). Because of its direct interface with neural tissue, cerebrospinal fluid (CSF) is a potentially valuable source for biomarker development. This systematic review was conducted using three databases. All trials investigating clinical and preclinical models for CSF biomarkers for AIS diagnosis, prognostication, and severity grading were included, yielding 22 human trials and five animal studies for analysis. In total, 21 biomarkers and other multiomic proteomic markers were identified. S100B, inflammatory markers (including tumor necrosis factor-alpha and interleukin 6), and free fatty acids were the most frequently studied biomarkers. The review showed that CSF is an effective medium for biomarker acquisition for AIS. Although CSF is not routinely clinically obtained, a potential benefit of CSF studies is identifying valuable biomarkers from the pathophysiologic microenvironment that ultimately inform optimization of targeted low-abundance assays from peripheral biofluid samples (e.g., plasma). Several important catabolic and anabolic markers can serve as effective measures of diagnosis, etiology identification, prognostication, and severity grading. Trials with large cohorts studying the efficacy of biomarkers in altering clinical management are still needed.

The Prognostic Biomarkers of Plasma Trimethylamine N-Oxide and Short-Chain Fatty Acids for Recanalization Therapy in Acute Ischemic Stroke.

Bidirectional communication of the microbiota-gut-brain axis is crucial in stroke. Recanalization therapy, namely intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT), are recommended for eligible patients with acute ischemic stroke (AIS). It remains unclear whether gut microbiota metabolites, namely trimethylamine N-oxide (TMAO) and short-chain fatty acids (SCFAs), can predict the prognosis after recanalization therapy. This prospective study recruited patients with AIS receiving IVT, EVT, or both. The National Institutes of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS) scores were used to assess the severity and functional outcomes of AIS, respectively. A functional outcome of mild-to-moderate disability was defined as a mRS score of 0-3 at discharge. Plasma TMAO and SCFA levels were measured through liquid chromatography with triple-quadrupole mass spectrometry. Fifty-six adults undergoing recanalization therapy for AIS were enrolled. Results showed that TMAO levels were not associated with stroke severity and functional outcomes, while isovalerate levels (one of the SCFAs) were negatively correlated with NIHSS scores at admission and discharge. In addition, high isovalerate levels were independently associated with a decreased likelihood of severe disability. The study concluded that an elevated plasma isovalerate level was correlated with mild stroke severity and disability after recanalization therapy for AIS.

Increased plasma levels of circPTP4A2 and circTLK2 are associated with stroke injury.

Accumulating studies have shown that circulating circular RNAs (circRNAs) represent novel biomarkers for many human diseases. We investigated whether plasma circPTP4A2 and circTLK2 levels are associated with stroke severity, infarct volume, stroke etiology, and functional outcome in acute ischemic stroke (AIS) patients. We applied quantitative real-time PCR (qPCR) to measure plasma circPTP4A2 and circTLK2 levels of 236 AIS patients within 72 h of symptoms onset and 136 healthy controls. We further assessed the National Institutes of Health Stroke Scale (NIHSS), infarct size, the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification and the 90-day modified Rankin scale (mRS) for each patient. At admission, plasma circPTP4A2 and circTLK2 levels in patients with moderate to severe stroke were significantly higher compared to those with mild stroke. Logistic regression and receiver-operating characteristic (ROC) curve analyses indicated that they might function as predictive biomarkers for moderate to severe stroke. We also observed a medium positive correlation between these two circRNAs and NIHSS. Plasma circPTP4A2 and circTLK2 levels were slight positively correlated with cerebral infarct volume only in anterior circulation infarction (ACI) patients. Levels of both circPTP4A2 and circTLK2 were closely related with large artery atherosclerosis (LAA) stroke. Moreover, changes within 7 days after admission in circPTP4A2 and circTLK2 were able to predict unfavorable clinical outcome 90 days after AIS. These results demonstrate that plasma circPTP4A2 and circTLK2 strongly correlated with severity, subtypes and prognosis of AIS, and they could serve as promising biomarkers.

Correlations between NLR, NHR, and clinicopathological characteristics, and prognosis of acute ischemic stroke.

Neuroinflammation plays an essential role in the process of acute ischemic stroke (AIS) injury repair. The current study seeks to investigate the relationship between the neutrophil/lymphocyte ratio (NLR) and neutrophil/high-density lipoprotein cholesterol ratio (NHR) and AIS disease severity and short-term prognosis. As such, the primary aim of this study is to improve AIS diagnosis and treatment. A total of 136 patients with AIS at the Nantong Third People's Hospital were retrospectively analyzed. The inclusion criteria comprised patients with ischemic stroke admitted to the hospital <24 hours after symptom onset. Baseline, clinical, and laboratory data were collected from all patients within 24 hours of admission. Univariate, multivariate and receiver operating characteristic curve analysis were performed to determine the relationship between NLR, NHR, AIS severity, and short-term prognosis. NLR (odds ratio [OR] = 1.448, 95% confidence interval [CI] 1.116-1.878, P = .005) and NHR (OR = 1.480, 95% CI 1.158-1.892, P = .002) were identified as independent risk factors for stroke severity. Additionally, the correlation between combined NLR and NHR and AIS severity achieved a sensitivity of 81.4% and specificity of 60.4% with a best cutoff value of 6.989. This outcome was superior to that of the single composite inflammatory index. Moreover, NLR (OR = 1.252, 95% CI 1.008-1.554, P = .042) was an independent risk factor for poor short-term prognosis in patients with AIS. When the optimal cutoff value was 2.605, the sensitivity of NLR correlation with the short-term prognosis of AIS was 82.2%, and the specificity was 59.3%. NLR combined with NHR exhibits a strong correlation with disease severity in AIS. Meanwhile, an elevated NLR in patients with AIS can predict a poor short-term prognosis.

Access to and application of recanalizing therapies for severe acute ischemic stroke caused by large vessel occlusion

BackgroundGroundbreaking study results since 2014 have dramatically changed the therapeutic options in acute therapy for severe ischemic stroke caused by large vessel occlusion (LVO). The scientifically proven advances in stroke imaging and thrombectomy techniques have allowed to offer the optimal version or combination of best medical and interventional therapy to the selected patient, yielding favorable or even excellent clinical outcomes within time windows unheard of before. The provision of the best possible individual therapy has become a guideline-based gold standard, but remains a great challenge. With geographic, regional, cultural, economic and resource differences worldwide, optimal local solutions have to be strived for.AimThis standard operation procedure (SOP) is aimed to give a suggestion of how to give patients access to and apply modern recanalizing therapy for acute ischemic stroke caused by LVO.MethodThe SOP was developed based on current guidelines, the evidence from the most recent trials and the experience of authors who have been involved in the above-named development at different levels.ResultsThis SOP is meant to be a comprehensive, yet not too detailed template to allow for freedom in local adaption. It comprises all relevant stages in providing care to the patient with severe ischemic stroke such as suspicion and alarm, prehospital acute measures, recognition and grading, transport, emergency room workup, selective cerebral imaging, differential treatment by recanalizing therapies (intravenous thrombolysis, endovascular stroke treatmet, or combined), complications, stroke unit and neurocritical care.ConclusionsThe challenge of giving patients access to and applying recanalizing therapies in severe ischemic stroke may be facilitated by a systematic, SOP-based approach adapted to local settings.

Sex-dependent outcomes of recanalization-treated acute ischemic stroke patients at Shamir (Assaf Harofeh) medical center, Israel, 2011–2020

Background/objectivesSex-based differences in incidence, etiologies, severity and recanalization treatment outcomes of patients with acute ischemic stroke (AIS) have been studied extensively. We set out to determine if there were sex-based differences in outcomes among AIS patients who received recanalization treatments at Shamir (Assaf Harofeh) Medical Center (SMC), Israel, between 2011 and 2020. MethodsThis was a single-center, retrospective chart review. The primary analysis compared outcomes for men and women, overall and stratifying by disease severity. We compared also demographics, risk factors and workflow data. ResultsEight hundred and eleven patients received recanalization treatment between 2011 and 2020: 472 (58.1%) men and 339 (41.8%) women. Mean age, NIHSS score and proportion with an NIHSS score ≥ 6 were higher for women. Cerebrovascular risk factors were more prevalent in women, particularly atrial fibrillation, except that current smoking was more prevalent in men. Six hundred and twenty patients (78.1%) were treated with TPA alone, 89 (11.2%) with TPA and endovascular treatment (EVT), and 85 (10.7%) with EVT alone. Fifty percent of patients were discharged home, 41% to a rehabilitation hospital or nursing home, and 9% did not survive. Twenty-four patients (3%) sustained symptomatic bleeds. Outcomes were worse in patients with NIHSS score ≥ 6. Outcomes did not differ by sex. ConclusionsWhile treated women presented with more severe AIS and more risk factors, we did not find significant sex-related differences in outcomes. Meticulous adherence to risk factor modification remains the best strategy to reduce stroke incidence, morbidity, and mortality in women and in men.

Association of Bun/Cr ratio-based dehydration status with infarct volumes and stroke severity in acute ischemic stroke

BackgroundOnly a few clinical research had previously investigated the dehydration status to predict the evolution of the ischemic core. The aim of this study is to clarify the association between blood urea nitrogen (BUN)/creatinine (Cr)ratio-based dehydration and infarct volume measured using DWI (Diffusion-weighted imaging) at admission in patients with AIS (Acute Ischemic Stroke). MethodsWe retrospectively recruited a total of 203 consecutive patients who were hospitalized through emergency or outpatient services within 72 h of acute ischemic stroke onset between October 2015 and September 2019. Stroke severity was measured by assessing the National Institutes of Health Stroke Scale (NIHSS) on admission. Infarct volume was measured using DWI with MATLAB software. ResultsIn this study, 203 patients who met the study criteria were enrolled. Patients in the dehydration group (Bun/Cr ratio>15) had a higher median NIHSS score (6(IQR:4–10) VS. 5(3−7); P = 0.0015)and larger DWI infarct volume (1.55 ml (IQR:0.51–6.79) VS. (0.37 ml (0.05–1.22); P < 0.001) on admission compared with patients in normal group. Further, a statistically significant correlation was found between DWI infarct volumes and NIHSS score with nonparametric Spearman rank correlation (r = 0.77; P < 0.001). The median NIHSS scores for the DWI infarct volumes quartiles were 3 ml (IQR, 2–4), 5 ml (4−7), 6 ml (5−8), and12 ml (8−17) from lowest to highest. However, the second quartile group did not show any significant correlation with the third quartile group (P = 0.4268). Multivariable linear and logistic regression analyses were used to test dehydration (Bun/Cr ratio>15), representing a predictor of infarct volume and stroke severity. ConclusionBun/Cr ratio-based dehydration is associated with larger volumes of ischemic tissue measured using DWI and worse neurological deficit assessed by the NIHSS score in acute ischemic stroke.

Association between plasma adiponectin levels and severity of acute ischemic stroke

There is little documentation describing the correlation between plasma adiponectin and the severity of ischemic stroke in the Indian population. The present study was aimed to find the correlation between plasma adiponectin levels and severity of acute ischemic stroke using the National Institute of Health Stroke Scale (NIHSS) and Modified Rankins Scale (MRS). The present prospective observational study was conducted on 109 patients of confirmed acute ischemic stroke aged ≥ 30 years presenting within 24 hours of new onset of neurodeficits. NIHSS and MRS were measured within 24 hours and 5 days after onset of symptoms respectively. Plasma adiponectin levels were measured. The primary objectives were to find the correlation of plasma adiponectin levels with severity of acute ischemic stroke using the NIHSS and neurological functional outcome using the MRS. The secondary objectives were to find an association of plasma adiponectin levels with serum lipid profile and comorbidities.There was a negative correlation between plasma adiponectin levels and NIHSS score (r = - 0.110, p-value = 0.253) and MRS (r = -0.041, p-value = 0.672) which was not statistically significant. The median plasma adiponectin levels were comparable between the groups of cases with co-morbidity and without co-morbidity. A significantly higher percentage of patients who had high triglyceride levels had normal plasma adiponectin levels. The distribution of other lipid parameters and hypertension did not differ significantly between the groups of cases with normal and abnormal plasma adiponectin levels. There was no correlation between plasma adiponectin levels and severity of acute ischemic stroke.

Effect of COVID-19 on Acute Ischemic Stroke Severity and Mortality in 2020: Results From the 2020 National Inpatient Sample.

There is a paucity of nationally representative data regarding the impact of COVID-19 on acute ischemic stroke (AIS) outcome. We created a cross-sectional cohort of nationally weighted National Inpatient Sample nonelective hospital discharges aged ≥18 years with a diagnosis of ischemic stroke from 2016 to 2020. The outcome was in-hospital mortality and exposure was COVID-19 status. To understand the effect of COVID-19 on AIS severity, we report National Institutes of Health Stroke Scale by exposure status. In a final analysis, we used a nationally weighted logistic regression and marginal effects to compare April to December 2020 to the same period in 2019 to understand how the pandemic modified the effect of race and ethnicity and median household income on in-hospital AIS mortality. We observed significantly higher AIS mortality in 2020 than prior years (2020 versus 2016-19, 7.3% versus 6.3%, P<0.001) and higher National Institutes of Health Stroke Scale in those with COVID-19 than those without (mean: 9.7±9.1 versus 6.6±7.4, P<0.001), but patients with AIS without COVID in 2020 had only marginally higher mortality (2020 versus 2016-2019, 6.6% versus 6.3%, P=0.001). Comparing April to December 2020 to 2019, the adjusted risk of in-hospital AIS mortality was most notably increased in Hispanics (2020 versus 2019: 9.2% versus 5.8%, P<0.001) and the lowest quartile of income (2020 versus 2019: 8.0% versus 6.0%, P<0.001). In-hospital stroke mortality increased in 2020 in the United States because of comorbid AIS and COVID-19, which had higher stroke severity. The increase in AIS mortality during April-December 2020 was significantly more pronounced in Hispanics and those in the lowest quartile of household income.

Correlation between serum parathyroid hormone-associated protein concentration and acute ischemic stroke

Objective To investigate the correlation between serum Parathyroid hormone-related protein (PTHrP) and acute ischemic stroke (AIS). Methods from October 2020 to March 2021, 134 patients with AIS and 34 healthy individuals were enrolled. Serum PTHrP concentration was measured by enzyme-linked immunosorbent assay (ELISA) and subgroup analysis was performed according to Trial of Org 10 172 in acute stroke treatment (TOAST) classification. The severity of AIS was assessed by the National Institutes of Health stroke scale (NIHSS) score and the volume of cerebral infarction was assessed based on head magnetic resonance imaging. The correlation of serum PTHrP concentration with various indicators was analyzed. The 90-day functional prognosis of patients was assessed by the modified Rankin scale. Patients were divided into favorable outcomes group and unfavorable outcomes group and the difference in serum PTHrP concentration between the two groups was compared. Whether serum PTHrP was associated with AIS prognosis was analyzed by Logistic regression.Results The serum PTHrP concentration in AIS group was higher than that in the control group (P=0.000), and the serum PTHrP concentrations of the three common etiological subtypes, LAA, CE and SAO, were higher than those in the control group (all P&lt;0.01). The AUC for distinguishing AIS patients and healthy control by serum PTHrP concentration was 0.751(P&lt;0.0001). The serum PTHrP concentration in the AIS group was associated with the cumulative smoking volume (r=0.201, P=0.021) and APTT (r=-0.188, p=0.034). Serum PTHrP was not associated with TOAST classification (P=0.091), NIHSS score and cerebral infarction volume (all P&gt;0.05), and there was no significant difference in serum PTHrP concentration between the favorable outcomes group and unfavorable outcomes group (P&gt; 0.05). Univariate logistic regression showed that serum PTHrP concentration was not a prognostic factor of AIS [OR=1.000 95% CI (0.999, 1.002) P=0.678]. Conclusion Serum PTHrP concentration was significantly increased in AIS patients. Serum PTHrP might be ancillary for early identification of AIS. Serum PTHrP concentration correlated with cumulative smoking volume and APTT in AIS patients, and could possibly be used to assess the true smoking volume of patients and analyze coagulation function. However, serum PTHrP concentration was not associated with TOAST classification, NIHSS score, cerebral infarction volume and 90-day prognosis, which meant it cannot be used to evaluated the etiology, severity and prognosis of AIS patients.

Fasting blood glucose-to-glycated hemoglobin ratio for evaluating clinical outcomes in patients with ischemic stroke.

Stress hyperglycemia frequently occurs in patients with acute ischemic stroke (AIS). The influence of stress hyperglycemia on the outcomes of patients with AIS remains ambiguous. Data from our institution on patients with AIS between June 2020 and June 2021 were retrospectively analyzed. The severity of the stroke was assessed using the National Institutes of Health Stroke Scale (NIHSS) at admission, and the primary endpoint was functional outcomes. Stress hyperglycemia was measured by the glucose-to-HbA1c ratio. In the multivariable analysis, two models that retained or excluded the NIHSS were adopted to explore the relationship between stress hyperglycemia and outcomes. The receiver operating characteristic curve (ROC) was calculated to determine an optimized cutoff value. The optimal cutoff value was 1.135. When all patients were included, model 1 did not find an association between the glucose-to-HbA1c ratio and functional outcomes. In model 2, the glucose-to-HbA1c ratio×10 (Glucose-to-HbA1c ratio ×10) was the independent predictor of functional outcomes (OR 1.19, 95% CI 1.07-1.33, p < 0.01). Separately, in patients without diabetes, the glucose-to-HbA1c ratio×10 was the independent predictor of functional outcomes in both model 1 (OR 1.37, 95% CI 1.08-1.73, p = 0.01) and model 2 (OR 1.48, 95% CI 1.22-1.79, p < 0.01), but not in patients with diabetes. In addition, the glucose-to-HbA1c ratio×10 was the independent predictor of stroke severity (OR 1.16, 95% CI 1.05-1.28, p < 0.01). The glucose-to-HbA1c ratio was associated with more severe AIS. Specifically, the glucose-to-HbA1c ratio was associated with the functional outcomes in patients without diabetes but not in patients with diabetes.

Serum asprosin levels in patients with acute ischemic stroke

Objective: This study aimed to investigate the association between serum asprosin and the incidence, severity, etiological subtypes and thrombolysis therapy of acute ischemic stroke (AIS). Methods: A total of 130 patients with AIS were included; 50 patients matched for age, sex, and vascular risk factors, and 50 healthy subjects matched only for age and sex were used as the control group. The National Institutes of Health Stroke Scale was used to estimate the severity of stroke. Scores &gt;6 were considered to indicate a moderate-to-severe stroke. The AIS group was divided into 3 etiological subtype groups according to the Toast classification method. The thrombolytic and non-thrombolytic groups were divided according to whether emergency thrombolytic treatment was performed. Results: The asprosin level was significantly higher in the AIS group than in the control group (p&lt;0.001). Further, the asprosin level was higher in the moderate-to-severe stroke group than in the minor stroke group (p&lt;0.001). Logistic regression analysis showed that asprosin was an independent risk factor for AIS and AIS severity. The areas under the receiver operating characteristic curve of serum asprosin for predicting AIS and moderate-to-severe stroke were 0.671 (95% confidence interval: 0.587–0.755; p&lt;0.001) and 0.778 (95% confidence interval: 0.698–0.858; p&lt;0.001), respectively. There was no statistically significant difference in serum asprosin levels in the etiological subtype of AIS and thrombolytic therapy or not. Conclusion: Serum asprosin levels are positively associated with the incidence and severity of AIS and can be used as biomarkers for predicting the occurrence of AIS. Serum asproisn levels may not be used to differentiate between different etiologic subtypes of acute ischemic cerebral infarction and thrombolytic therapy or not.

A STUDY ON THE CORRELATION BETWEEN SERUM CORTISOL LEVELS AND SEVERITY OF ACUTE ISCHEMIC STROKE.

INTRODUCTION: There are many clinical variables like symptom severity and advanced age which are identied as potential predictors of outcome in patients with acute stroke. But there is an immense need to detect a biomarker for predicting the outcome of acute stroke. The stress response that occurs after the event of acute stroke causes the activation of the hypothalamic–pituitary–adrenal (HPA) axis. Certain studies have found that increased serum cortisol level in patients with acute stroke is related to larger infarct volume, greater stroke severity and poor outcome, including death AIM AND OBJECTIVE: To assess the relationship of single serum cortisol levels to the severity of acute ischemic stroke. MATERIALS AND METHODS: About 50 new cases of acute ischemic stroke patients, within 72 hours of the acute neurological event, who were admitted to the Chalmeda Anand Rao institute of medical sciences, Karimnagar, Telangana were included in the study. The study was conducted for 6 months.CT Brain was taken during admission to conrm acute ischemic stroke. NIHSS (National Institute of Health Stroke Scale) scores for all the patients were assessed for severity at the time of admission. Serum cortisol levels were measured the next day early morning. After 15 days, the functional outcome of the patients was assessed using the Modied Rankin Scale. The correlation between serum cortisol levels and stroke scales is assessed byChi–Square Test. All statistical analyses are performed using SPSS (software package used for statistical analysis) package. RESULTS: Of the 50 cases, the serum cortisol level of 23 cases was within normal limits(&lt;/=690nmol/L) of which 65.2% had NIHSS scores of less than or equal to 6 and 34.8% of the cases had NIHSS scores more than 6. As the NIHSS score of less than or equal to 6 is considered to be a minor stroke, it is obvious from the above ndings that most of the cases with normal cortisol levels had no major stroke. The remaining 27 cases had elevated serum cortisol levels.100% of the cases with serum cortisol levels of more than 690nmol/L had NIHSS scores above 6. With a p-value of &lt;0.001, this is found to be statistically signicant. As the NIHSS score above 6 is considered to be moderate to severe stroke, it is obvious from the above observation that nearly all cases with elevated cortisol levels had moderate to severe stroke. Of the 50 cases, serum cortisol levels of 23 cases were within normal limits(,/=690nmol/L)of which 78.3% had MRS scores less than or equal to 3 and 21.7% had MRS scores more than 3. Since the MRS score is a measure of functional outcome and any score less than or equal to 3 is considered to have a favourable outcome, it is clear from the above ndings that most of the cases with normal serum cortisol had a favourable outcome with minimal neurological impairment. And in the remaining 27 cases which had serum cortisol levels of more than 690 nmol/L, 3.7% had an MRS score of less than or equal to 3 and 96.3% had an MRS score of more than 3. With a p-value of &lt;0.001, this is statistically signicant. Since an MRS score of more than 3 is associated with a bad outcome, most of the cases with elevated serum cortisol had a poor outcome with severe neurological impairment. CONCLUSION: Among the patients with acute ischemic stroke, high serum cortisol levels at the time of admission correlate with, Clinical severity which is assessed by the National Institute of Health Stroke Scale and Poor prognosis and functional outcome after 15 days which is assessed by the Modied Rankin Scale

GAS6/sAXL ratio correlates with National Institutes of Health Stroke Scale (NIHSS) and infarction size in patients with acute ischemic stroke

Background &amp; Objective: Ischemic stroke is the leading cause of death and long-term disability worldwide. In patients with ischemic stroke, both cell loss and inflammation are observed. GAS6/sAXL signaling is effective in both inflammation and clearance of dead/dying cells. This study investigated the GAS6/sAXL pathway and its role in patients with acute stroke. Specifically, we evaluated whether GAS6/sAXL was associated with stroke severity and infarct volume. Methods: This study involved 53 patients with acute ischemic stroke (AIS) and 49 healthy controls. GAS6 and sAXL proteins were collected in the first 24 hours in the acute stroke. NIHSS scores, GCS, and demographic data of the patients at the time of admission to the hospital were recorded. The infarct area was calculated using cranial magnetic resonance imaging. Results: Mean age of the patients was 64±12 years, 60% were female. HDL was lower in AIS group (40.5±13.01 mg/dl) than in the control group (55.4±14.9 mg/ dl) (p&lt;0.05). The GAS6 levels of patients with ischemic stroke (30.58 [1.58-162.33] ng/dL) were significantly lower than the control group (83.33 [10.71-181.96] ng/dL) (p &lt; 0.001). There was a significant difference in the GAS6/sAXL ratio between the AIS (8.60 [0.55-48] ng/mL) and control groups (14.78 [1.82-53.71] ng/mL) (p &lt; 0.001). The serum GAS6 level and MR infarct area was positively correlated (r = 0.381 p = 0.005). The GAS6/sAXL ratio was positively correlated with the NIHSS and infarct area (p = 0.004). The GAS6/sAXL ratio and GCS showed a negative correlation (p = 0.001). Conclusion: Plasma GAS6 levels were positively correlated with infarct size, and the GAS6/sAXL ratio was positively correlated with the NIHSS score and infarct area in patients with AIS. Plasma GAS levels and GAS6/sAXL ratio can be used as an indicator of severity of AIS.

Modeling flow in an in vitro anatomical cerebrovascular model with experimental validation.

Acute ischemic stroke (AIS) is a leading cause of mortality that occurs when an embolus becomes lodged in the cerebral vasculature and obstructs blood flow in the brain. The severity of AIS is determined by the location and how extensively emboli become lodged, which are dictated in large part by the cerebral flow and the dynamics of embolus migration which are difficult to measure in vivo in AIS patients. Computational fluid dynamics (CFD) can be used to predict the patient-specific hemodynamics and embolus migration and lodging in the cerebral vasculature to better understand the underlying mechanics of AIS. To be relied upon, however, the computational simulations must be verified and validated. In this study, a realistic in vitro experimental model and a corresponding computational model of the cerebral vasculature are established that can be used to investigate flow and embolus migration and lodging in the brain. First, the in vitro anatomical model is described, including how the flow distribution in the model is tuned to match physiological measurements from the literature. Measurements of pressure and flow rate for both normal and stroke conditions were acquired and corresponding CFD simulations were performed and compared with the experiments to validate the flow predictions. Overall, the CFD simulations were in relatively close agreement with the experiments, to within ±7% of the mean experimental data with many of the CFD predictions within the uncertainty of the experimental measurement. This work provides an in vitro benchmark data set for flow in a realistic cerebrovascular model and is a first step towards validating a computational model of AIS.