Clinical and Radiological Evaluation of Severity of Acute Ischemic Stroke with Special Reference to Neuroinflammatory Biomarkers.

Abstract

Background: Given the complexity of stroke, diverse mechanisms are known to be involved in its pathophysiology among which inflammation is one of the major culprits. Poor clinical outcomes are seen in those stroke patients with significant systemic inflammation. Therapeutic options to fight stroke are still limited and the only approved drug is tissue-plasminogen activator and/or mechanical thrombectomy. As inflammation highly influences susceptibility of stroke patients to overcome the disease, there is an increasing need to develop new diagnostic, prognostic, and therapeutic strategies for poststroke inflammation.

Subjects and methods: This study was conducted over a period of 18 months. Seventy-five patients who were diagnosed with acute ischemic stroke based on patient's clinical history, neurological signs, and radioimaging were included. Patients underwent computed tomography scan/magnetic resonance imaging scan within 24 h of admission to exclude stroke mimics and primary intracerebral hemorrhage. National Institutes of Health Stroke Scale (NIHSS) was used to assess the severity of stroke clinically. Inflammatory biomarkers such as plasma MMP-9, high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and S100B were measured using the ELISA kits.

Results: We observed that plasma concentration of MMP-9, IL-6, and S100B showed statistical significant association with severity of stroke as assessed by NIHSS, with Chi-square test values of χ2 = 24.69 for IL-6 (P = 0.00), χ2 = 11.91 for S100B (P = 0.008), and χ2 = 19.5 for MMP-9 (P = 0.00). The mean values of MMP-9, IL-6, S100B levels, and hs-CRP levels were significantly elevated in severe, moderately to severe stroke groups as related with mild stroke group as evaluated by NIHSS.

Conclusion: Neuroinflammatory markers such as MMP-9, IL-6, S100B, and hs-CRP are the promising tool as inflammatory biomarkers with other indicators of acute ischemic injury to diagnose acute ischemic stroke and facilitate a better clinical assessment of patients during the acute phase of the disease. More importantly, this study showed that these biomarkers have strong independent prediction values for stroke outcome. We propose that some of those biomarkers might turn out to be targets to be therapeutically altered overcoming the urgent need for the identification of potent drugs to modulate stroke-associated inflammation.