Biomarkers — predictors of mortality in patients with ischemic stroke

A. M. Golubev, M. Radutnaya, Vladislav E. Zakharchenko, A. Babkina, M. V. Petrova, Maksim A. Lyubomudrov, M. Yadgarov, Ekaterina L. Bondar, Alexander L. Parfenov, A. V. Grechko
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Abstract

BACKGROUND: Stroke is a global health problem and the second leading cause of death worldwide, with ischemic stroke accounting for the majority of acute cerebrovascular accidents. Predicting outcomes in patients with ischemic stroke is challenging due to the limited prognostic performance of existing models. The lack of reliable and predictive biomarkers of ischemic stroke used in clinical practice provides a rationale for studies to address this issue. AIM: The aim of this study was to identify clinical, demographic, neuroimaging and molecular biomarkers of ischemic stroke associated with the fatal outcome of the disease. MATERIALS AND METHODS: We retrospectively analyzed cases of ischemic stroke confirmed by computed tomography of the brain with a duration of 3 months or less. As factors potentially related to the outcome of ischemic stroke, we considered (1) clinical and demographic characteristics, including sex, age, history of acute cerebrovascular accident, time from stroke to hospitalization, phase and type of stroke, neurological status on admission (level of consciousness, FOUR coma scale), comorbidities (diabetes mellitus, infectious complications, oncological diseases); (2) molecular biomarkers including blood glucose and neuron-specific enolase (NSE) levels at different phases of stroke; (3) neuroimaging biomarkers such as number and location of stroke lesion, total infarct volume, signs of edema, hemorrhagic component according to computed tomography. RESULTS: 38 patients with ischemic stroke were included in the study. Lesion volume was larger in non-survivors: 123 [44.6–206.2] versus 42.7 [8.2–88.7] ml3 (p=0.032), and cerebral edema was detected significantly more often on admission CT scan than in survivors: 7 (77.8%) versus 10 (34.5%), p=0.022. Stroke lesion volume was a predictor of mortality (AUC 0.739; 95% CI 0.542–0.937; p=0.032). The optimal cut-off for stroke lesion volume was found to be 90 ml3. CONCLUSION: Signs of edema/brain stem dislocation and cerebral lesion volume 90 ml3 documented at hospital admission are predictors of fatal outcome. Therefore, neuroimaging biomarkers can be used for risk stratification of fatal outcome in ischemic stroke patients.
生物标志物--缺血性中风患者死亡率的预测因素
背景:脑卒中是一个全球性健康问题,也是全球第二大死亡原因,其中缺血性脑卒中占急性脑血管意外的大多数。由于现有模型的预后性能有限,预测缺血性中风患者的预后具有挑战性。临床实践中缺乏可靠的缺血性卒中预测性生物标志物,这为研究解决这一问题提供了依据。目的:本研究旨在确定与缺血性卒中致命结局相关的临床、人口统计学、神经影像学和分子生物标志物。材料与方法:我们回顾性分析了经脑部计算机断层扫描确认的病程为 3 个月或更短的缺血性中风病例。作为与缺血性脑卒中结局潜在相关的因素,我们考虑了(1)临床和人口统计学特征,包括性别、年龄、急性脑血管意外史、从脑卒中到住院的时间、脑卒中的阶段和类型、入院时的神经状态(意识水平、FOUR 昏迷量表)、合并症(糖尿病、感染性并发症、肿瘤疾病);(2) 分子生物标志物,包括中风不同阶段的血糖和神经元特异性烯醇化酶(NSE)水平;(3) 神经影像学生物标志物,如中风病灶的数量和位置、梗死总体积、水肿迹象、计算机断层扫描显示的出血成分。结果:38 名缺血性脑卒中患者被纳入研究。非幸存者的病灶体积更大:123 [44.6-206.2] ml3 对 42.7 [8.2-88.7] ml3(P=0.032),入院 CT 扫描发现脑水肿的频率明显高于幸存者:7(77.8%)对 10(34.5%),P=0.022。卒中病灶体积是死亡率的预测因子(AUC 0.739;95% CI 0.542-0.937;P=0.032)。卒中病灶体积的最佳临界值为 90 ml3。结论:入院时记录的水肿/脑干脱位体征和脑损伤体积 90 ml3 是致命结局的预测因素。因此,神经影像生物标志物可用于缺血性卒中患者致命结局的风险分层。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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