scholarly journals Prognostic Value of Inflammatory Mediators in 1-Year Outcome of Acute Ischemic Stroke with Middle Cerebral Artery Stenosis

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Xiping Gong ◽  
Xinying Zou ◽  
Liping Liu ◽  
Yuehua Pu ◽  
Yilong Wang ◽  
...  

Background and Purpose. Inflammation exists in inception, progression, and reperfusion of acute ischemic stroke. Insightful understanding of correlation in inflammatory mediators and stroke severity with intracranial artery stenosis may improve rational stroke therapy.Methods. We prospectively recruited 977 patients with acute noncardioembolic ischemic stroke with MCA stenosis by MRA as none to mild (<50%), moderate (50–69%), severe (70–99%), or occlusive (100%). The peripheral levels of WBC, homocysteine (HCY), and high sensitivity C-reactive protein (hs-CRP) were recorded. All patients were assessed of 1-year outcome by mRS as favorable (0–2) or poor (3–6).Results. The levels of WBC, HCY, and hs-CRP had no significant differences in patients with categorized MCA stenosis (all . Higher levels of WBC, HCY, and hs-CRP were found in patients with 1-year poor outcome (all , but only hs-CRP is an independent predictor (OR 1.06, 95% CI 1.027–1.093, . The combination of any two of increased hs-CRP (>3 mg/L), WBC (>6.91 × 109/L), and HCY (>15 μmol/L) had higher power in predicting 1-year poor outcome than the single elevated mediator.Conclusions. Elevated hs-CRP independently predicts 1-year poor outcome in acute stroke. The combination of increased hs-CRP, WBC, or HCY had a stronger predictive value in poor outcome than individual elevated mediator.

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Jae Guk Kim ◽  
Youngchai Ko ◽  
Soo Joo Lee

Background and Objectives: Inflammation plays an important role in atherosclerosis and its clinical sequelae. Their relationship to stroke is not settled. We assessed the hypothesis that relative elevations of high-sensitivity C-reactive protein (hs-CRP) and lipoprotein-associated phospholipase A2 (Lp-PLA2) levels at the time of first stroke are associated with stroke severity and prognosis. Methods: First ischemic stroke patients who was admitted within 7days after stroke onset, were prospectively enrolled. High-sensitivity C-reactive protein and Lp-PLA2 level were assayed using the enzyme-linked immunoassay. Vascular risk factors, stroke subtypes, and initial stroke severity were assessed. Stroke severity was evaluated using the National Institutes of Health Stroke Scale (NIHSS) and was categorized as mild (NIHSS score<6), moderate (NIHSS score of 6-13), or severe (NIHSS score≥14). The unfavorable outcome was defined as the modified Rankin Scale of 2-6 at 3month after stroke onset. Results: Two hundred two patients (mean age, 67.5 years; 52.5% male) were included; 104 (51.5%) had unfavorable outcome. Levels of hs-CRP and Lp-PLA2 were weakly correlated (Spearman’s rho=0.174, p=0.01). In univariate analyses, female (p=0.03), patients with large artery atherosclerosis of stroke subtypes (p<0.01), severe NIHSS score (p=0.01), and unfavorable outcome (p<0.01) showed the higher mean value level of hs-CRP level than the others. Patients with hypertension (p=0.03), large artery atherosclerosis (p<0.01), severe NIHSS score (p<0.01), and unfavorable outcome (p=0.01) also had the higher mean value of Lp-PLA2 level than the others. After adjusting for age, sex, vascular risk factors, and initial stroke severity, the high level of hs-CRP was associated with unfavorable outcome (1.71±4.2 vs. 0.26±0.45, odds ratio (OR) 1.82, 95% confidence interval (CI) 1.02-3.27, p=0.04). However, after adjusting for the confounders, Lp-PLA2 was not associated with unfavorable outcome (191.33±77.78 vs. 162.02±61.54, OR 1.00, 95% CI 0.99-1.01, p=0.66). Conclusion: Our findings suggest that the level of hs-CRP and Lp-PLA2 were associated with stroke severity, but only hs-CRP may be useful to predict functional outcome at 3 month after ischemic stroke.


2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Xiaohao Zhang ◽  
Zhiguang Sun ◽  
Caixia Ding ◽  
Yinyan Tang ◽  
Xuemei Jiang ◽  
...  

Background and Aims. Metabolic syndrome (MetS) has been associated with occurrence and prognosis of ischemic stroke. This study aimed to evaluate whether an association exists between MetS and early neurological deterioration (END) following acute ischemic stroke and the possible role inflammatory biomarkers play.Methods and Results. We conducted a prospective cohort investigation that involved 208 stroke patients within 48 hours from symptom onset. MetS was determined by the modified National Cholesterol Education Program/Adult Treatment Panel III criteria. END was defined as an increase of⩾1 point in motor power or⩾2 points in the total National Institutes of Health Stroke Scale (NIHSS) score within 7 days. Univariate logistic regression analysis showed that patients with MetS had a 125% increased risk of END (OR 2.25; 95% CI 1.71–4.86,P=0.005). After adjustment for fibrinogen and high-sensitivity C-reactive protein, MetS remained significantly correlated to END (OR 2.20; 95% CI 1.10–4.04,P=0.026) with a 77% elevated risk per additional MetS trait (OR 1.77; 95% CI 1.23–2.58,P=0.002).Conclusions. This study demonstrated that MetS may be a potential predictor for END after ischemic stroke, which was independent of raised inflammatory mediators.


2018 ◽  
Vol 5 (3) ◽  
pp. 578 ◽  
Author(s):  
Sonika Pandey ◽  
K. K. Kawre ◽  
P. Dwivedi

Background: Stroke, a serious neurological disease is a major cause of death and disability throughout world. The pathophysiology of stroke involves inflammatory pathways, oxidative damage, apoptosis, angiogenesis and neuroprotection. High sensitivity C - reactive protein (hs-CRP) is associated with atherosclerosis and predict incident stroke in many patients. Objective of present study was to find out change in pattern of hs-CRP in acute ischemic stroke (AIS) patients during 3-months follow up and its prognostic significance.Methods: Single centre prospective cross-sectional time bound study. 256 were screened and 130 meet the inclusion and exclusion criteria, of which 100 gave informed consent and 80 patients completed the study at 3 months. Demographic, clinical parameters including NIHSS scoring, biochemical analysis was collected at enrolment, discharge and at end of the study.Results: hs-CRP levels in AIS increased significantly (within 24 hours of stroke) and continued to increase further at discharge, while decreased significantly during 3 months follow up. >7mg/dl hs-CRP at admission had 3.5 fold higher risk of mortality. Age >60 years, metabolic syndrome, hyperlipidemic, SBP >160mmHg and hs-CRP > 7 mg/dL increases relative risk in AIS stroke patients by 1.42, 1.09, 1.11, 1.577 and 3.23 fold respectively.Conclusions: hs-CRP increased significantly in AIS patients during 1st weeks of stroke with subsequent gradual decrease by the end of 3 months, the severity scoring system could determine prognosis on admission to ICU while hs-CRP is the main factor determining short as well as long term prognosis. We recommend serial measurements of hs-CRP for prognostication in AIS subjects.


Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Svetlana Lorenzano ◽  
Natalia S Rost ◽  
Ken Arai ◽  
Tijy Thankachan ◽  
Rebecca E Green ◽  
...  

Objectives: Identifying underlying stroke etiology plays critical role in acute management and secondary prevention strategies. Despite advanced diagnostics, up to 35% of ischemic strokes (IS) remain undetermined. We sought to evaluate the association between IS subtypes and plasma levels of biomarkers as representative of distinct etiologies underlying stroke subtypes. Methods: We prospectively measured plasma high sensitivity-C reactive protein (hs-CRP), matrix metalloproteinase (MMP)-2 and MMP-9, F2-isoprostane (F2-isoP), Oxygen Radical Absorbance Capacity assay (ORAC), homocysteine and urinary 8-hydroxydeoxyguanosine (8OHdG), in patients presenting within 9 hours from acute ischemic stroke (AIS) onset. Stroke subtype was assigned by a stroke neurologist according to the Causative Classification of Stroke System (CCSS) criteria. Results: There were 489 AIS subjects enrolled in this study [mean (SD) age 70.1 (15.1) y; 43.4% female; median (IQR) NIHSS 6 (3-13); 40.7% received IV tPA]. Among these AIS, 51% were of cardioembolic (CE), 17% of atherothrombotic, 7% of lacunar, 5% of other, and 20% of undetermined subtype. Patients with CE stroke were older and more likely to be female, non-smokers, have atrial fibrillation and congestive heart failure, but not carotid stenosis (all p<0.05). CE stroke subtype was also associated with greater stroke severity, and baseline levels of MMP-2 (p= 0.001) and ORAC (p= 0.008), as compared to other CCSS subtypes. In multivariate logistic regression analysis including all univariate predictors with p<0.05 as well as treatment with IV t-PA, baseline MMP-2 (OR 2.8, 95% CI 1.3-5.8; p= 0.006) and ORAC (OR 2.6, 95% CI 1.3-5.1; p= 0.007) was independently associated with CE stroke subtype. Conversely, the “other” stroke subtype was associated with lower levels of MMP-2 (OR 0.1, 95% CI 0.02-0.3; p= 0.001), and homocysteine levels were independently correlated with undetermined subtype (OR 2.2, 95% CI 1.2-4.1; p= 0.008). Conclusions: In AIS patients, hyperacute plasma biomarkers are associated with specific stroke subtypes, reflective of the underlying pathophysiology. If validated in future studies, plasma biomarkers may play valuable role in early diagnosis and guide management of specific AIS subtypes.


Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Yuko Abe ◽  
Ryoichi Otsubo ◽  
Sho Murase ◽  
Kenichiro Nakazawa ◽  
Kazuo Kitagawa

Purpose: A low ratio of serum eicosapentaenoic acid to arachidonic acid (EPA/AA) has been associated with atherosclerotic disease. Few studies investigate the association of serum fatty acid (FA) composition with the acute ischemic stroke so far. Our aim of this study is to evaluate the relationships between FA composition and stroke subtypes, extra-/intracranial atherosclerotic stenoses, and other cerebrovascular indicators Methods: This study included 154 consecutive patients who were admitted to our hospital because of acute ischemic stroke between April 2011 and March 2012. We examined the FA composition and classical vascular risk factors. We conducted brain MRI/MRA, carotid ultrasonogram, transthoracic echocardiogram, 24hr Holter electrocardiogram, ankle brachial index (ABI) and pulse wave velocity (PWV) in order to evaluate the severity of atherosclerotic change, stroke subtype, and cardiovascular status. Results: The mean value of EPA/AA was 0.33±0.22 in all patients with acute cerebral infarction. The 154 patients in this study (mean age 71 years) were categorized as follows; large artery atherosclerosis (LA; n=57), small artery occlusion (SA; n=48), cardiogenic embolism (CE; n=18), and others (n=31). We found intracranial artery stenosis greater than 50% in 70 patients (45%). The intracranial artery stenosis was associated with low EPA/AA ratio (P=0.013) and low EPA concentration (P=0.013). This association remained significant (P<0.05) after controlling for classical atherosclerotic risk factors. We could not find a significant correlation between FA composition and stroke subtype. However, there was a tendency for the EPA/AA ratio of LA patients to be the lowest among all subtype groups. The EPA/AA ratio was not associated with ABI, PWV, prevalence of arrhythmia, or cardiac function. Conclusions: A low EPA/AA ratio was significantly associated with intracranial stenosis in patients with acute ischemic stroke. This study shows the EPA/AA ratio might be an important marker to reflect the cerebral artery stenosis.


Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Hyun-Ji Cho ◽  
Yong Jae Kim

Background and Object: Intracranial artery stenosis (ICAS) is a common cause of acute ischemic stroke and has characteristics of poor prognosis and high recurrence. The role of plasma lipid level as risk factors for ICAS, still has controversy. So we investigated the relationship between the levels of the major lipids, apolipoproteins (Apo), lipoprotein (LP) and ICAS in acute ischemic stroke patients. Method: We assessed the clinical data of 881 consecutive patients from the stroke registry who were admitted due to TIA or acute ischemic stroke between November 2007 and January 2011. The major lipid levels [total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C)], the levels of Apo B100, Apo A-I and lipoprotein A [Lp (a)] and the level of high sensitivity C reactive protein (Hs-CRP) and were measured within three days after admission. The arterial segments were classified as normal, < 50 % stenosis or ≥ 50% stenosis on magnetic resonance angiography. ICAS was defined when at least one artery had ≥ 50% stenosis. Results: Of the total 881 patients, ICAS was found in 422 patients (31.0%, mean age: 66.17 ± 11.79 year old, males: 307), and 460 (55.7%) patients without ICAS were analyzed as a reference group. Compared with the reference group, the patients with ICAS were older (P < 0.001) and they had a greater prevalence of hyperlipidemia (p=0.002), a previous history of stroke (P =0.004) and no statin medication history (P < 0.001). The serum concentration of Hs-CRP was significantly higher in the patients with ICAS. (P < 0.001) The level of TC, LDL-C, HDL-C, Apo B100, Apo A-I, ratio of Apo B100/A-I and Lp (a) showed no significant difference between the two groups. But with adjustment of age, hypertension, diabetes mellitus, smoking, a previous history of stroke and statin medication, the ratio of Apo B100/ Apo A-I was significant for ICAS, (p=0.010) and was also the level of Hs- CRP (P=0.023). The odds ratios (ORs) for the presence of ICAS for those patients in the top, second, third quartiles were 2.054 (95% CI, 1.218-3.464), 1.721(95% CI, 1.033-2.868), and 1.667(95% CI, 1.008-2.757) sequentially for the ratio of Apo B100/ Apo A-I . Conclusions: Our study showed that the ratio of Apo B100/ Apo A-I was independently associated with presence of ICAS.


PeerJ ◽  
2016 ◽  
Vol 4 ◽  
pp. e1866 ◽  
Author(s):  
Yu-Chin Su ◽  
Kuo-Feng Huang ◽  
Fu-Yi Yang ◽  
Shinn-Kuang Lin

Background. Cardiac morbidities account for 20% of deaths after ischemic stroke and is the second commonest cause of death in acute stroke population. Elevation of cardiac troponin has been regarded as a prognostic biomarker of poor outcome in patients with acute stroke.Methods. This retrospective study enrolled 871 patients with acute ischemic stroke from August 2010 to March 2015. Data included vital signs, laboratory parameters collected in the emergency department, and clinical features during hospitalization. National Institutes of Health Stroke Scale (NIHSS), Barthel index, and modified Rankin Scale (mRS) were used to assess stroke severity and outcome.Results.Elevated troponin I (TnI) > 0.01 µg/L was observed in 146 (16.8%) patients. Comparing to patients with normal TnI, patients with elevated TnI were older (median age 77.6 years vs. 73.8 years), had higher median heart rates (80 bpm vs. 78 bpm), higher median white blood cells (8.40 vs. 7.50 1,000/m3) and creatinine levels (1.40 mg/dL vs. 1.10 mg/dL), lower median hemoglobin (13.0 g/dL vs. 13.7 g/dL) and hematocrit (39% vs. 40%) levels, higher median NIHSS scores on admission (11 vs. 4) and at discharge (8 vs. 3), higher median mRS scores (4 vs3) but lower Barthel index scores (20 vs. 75) at discharge (p< 0.001). Multivariate analysis revealed that age ≥ 76 years (OR 2.25, CI [1.59–3.18]), heart rate ≥ 82 bpm (OR 1.47, CI [1.05–2.05]), evidence of clinical deterioration (OR 9.45, CI [4.27–20.94]), NIHSS score ≥ 12 on admission (OR 19.52, CI [9.59–39.73]), and abnormal TnI (OR 1.98, CI [1.18–3.33]) were associated with poor outcome. Significant factors for in-hospital mortality included male gender (OR 3.69, CI [1.45–9.44]), evidence of clinical deterioration (OR 10.78, CI [4.59–25.33]), NIHSS score ≥ 12 on admission (OR 8.08, CI [3.04–21.48]), and elevated TnI level (OR 5.59, CI [2.36–13.27]).C-statistics revealed that abnormal TnI improved the predictive power of both poor outcome and in-hospital mortality. Addition of TnI > 0.01 ug/L or TnI > 0.1 ug/L to the model-fitting significantly improvedc-statistics for in-hospital mortality from 0.887 to 0.926 (p= 0.019) and 0.927 (p= 0.028), respectively.Discussion.Elevation of TnI during acute stroke is a strong independent predictor for both poor outcome and in-hospital mortality. Careful investigation of possible concomitant cardiac disorders is warranted for patients with abnormal troponin levels.


2013 ◽  
Vol 62 (1) ◽  
pp. 26-31 ◽  
Author(s):  
Yong-Jae Kim ◽  
Seung-Min Lee ◽  
Hyun-Ji Cho ◽  
Hyun Ju Do ◽  
Chang Hyung Hong ◽  
...  

2018 ◽  
Vol 80 (3-4) ◽  
pp. 163-170 ◽  
Author(s):  
Xingyu Chen ◽  
Xiaorong Zhuang ◽  
Zhongwei Peng ◽  
Huili Yang ◽  
Liangyi Chen ◽  
...  

Background: To assess whether intensive statin therapy reduces the occurrence of microemboli in patients with acute ischemic stroke. Methods: Patients with acute ischemic stroke within 72 h of onset were randomized to the intensive statin (atorvastatin 60 mg/day, adjusted to 20 mg/day after 7 days) and control (atorvastatin 20 mg/day) groups. Combined aspirin and clopidogrel were used for antiplatelet therapy. Microemboli were monitored by transcranial Doppler on days 1 (pre-treatment), 3, and 7. Metalloproteinase-9 (MMP-9), high-sensitivity C-reactive protein (hs-CRP), and National Institutes of Health Stroke Scale (NIHSS) score were assessed on days 1 and 7. The modified Rankin scale (mRS) was used on day 90. The primary outcome was the proportion of patients with microemboli on day 3. Results: There were 35 (58.3%) and 30 (52.6%) patients with microemboli in the intensive statin (n = 60) and control (n = 57) groups, respectively, on day 1 (p = 0.342). On day 3, there were significantly less microemboli in the intensive statin group (n = 9; 15.0%) compared with controls (n = 16; 28.1%; p = 0.002). No difference was observed in MMP-9 and hs-CRP levels on day 1, but on day 7, MMP-9 (median 79.3 vs. 95.9 μg/L; p = 0.004) and hs-CRP (median 2.01 vs. 3.60 mg/L; p = 0.020) levels were lower in the intensive statin group compared with controls. There were no differences in NIHSS scores on days 1 and 7. There was no difference in mRS on day 90. Conclusion: Intensive atorvastatin therapy in patients with acute ischemic stroke reduces the occurrence of microemboli and inflammation, with no overt adverse events.


Author(s):  
Betsi Sumanti ◽  
Hexanto Hexanto ◽  
Widiastuti Widiastuti

   ASSOCIATION BETWEEN ALTERED HS-CRP LEVELS AND  COGNITIVE FUNCTION OF ISCHEMIC STROKE PATIENTSABSTRACTIntroduction: The incidence of cognitive impairment in acute ischemic stroke patients is increasing. The mechanism of the inflammatory effect, such as  elevated hs-CRP level, a  non-specific inflammatory marker  sensitive to chronic inflammation due to hypoperfusion as well other vascular risk, is thought to have an effect on cognitive function.Aims: To determine the relationship of cognitive function changes in acute phase of ischemic stroke with hs-CRP level changes on day 3 and day 7 after onset.Methods: This was a cross sectional study of 31 first-timer ischemic stroke patients who met inclusion and exclusion criteria. The level of hs-CRP was checked on the 3rd day and 7th day after onset, while MoCA-Ina was assessed on the 7th day after onset. Cognitive disturbance was considered if MoCA <26. Analyses was done using SPSS 2.0Results: The average onset of day 3 Hs-CRP concentration was 0.66 (0.12-16.67)mg/dl and the onset of day 7 was 5.455 (0.14-17.34)mg/dl. The mean change of hs-CRP level between 3 day and 7 day after onset was -0,16 (-3.32-4.95). There was a significant correlation between elevated hs-CRP levels on day 3 and day 7 after onset with cognitive function of acute ischemic stroke patients.Discussion: There was a significant correlation between elevated hs-CRP levels on day 3 and day 7 after onset with cognitive function of acute ischemic stroke patients.Keyword: Acute ischemic stroke, hs-CRP, MoCA-Ina scoresABSTRAKPendahuluan: Insidens penurunan fungsi kognitif pada pasien stroke iskemik akut semakin meningkat. Hal ini diduga dipengaruhi oleh mekanisme efek inflamasi, meliputi peningkatan kadar high sensitive-C reactive protein (hs-CRP), salah satu penanda inflamasi non-spesifik yang sangat sensitif pada inflamasi kronis, akibat hipoperfusi maupun karena risiko vaskuler lainnya.Tujuan: Mengetahui hubungan perubahan fungsi kognitif pasien stroke iskemik fase akut dengan perubahan kadar hs-CRP hari ke-3 dan hari ke-7 setelah awitan.Metode: Studi potong lintang terhadap penderita stroke iskemik pertama kali yang memenuhi kriteria inklusi dan eksklusi. Dilakukan pemeriksaan kadar hs-CRP hari ke-3 dan hari ke-7 setelah awitan dan MoCA-Ina pada hari ke-7 setelah awitan. Fungsi kognitif dinyatakan terganggu jika MoCA-Ina <26. Analisis data menggunakan program SPSS 22.0.Hasil: Didapatkan rerata kadar Hs-CRP hari ke-3 setelah awitan adalah 0,66 (0,12-16,67)mg/dl dan hari ke-7 setelah awitan adalah 5,455 (0,14-17,34)mg/dl. Dengan rerata perubahan kadar hs-CRP awitan hari ke-3 dan awitan hari ke-7 adalah -0,16 (-3,32-4,95). Didapatkan hubungan yang bermakna antara perubahan kadar hs-CRP hari ke-3 setelah awitan dan hari ke-7 setelah awitan dengan fungsi kognitif pasien stroke iskemik akut.Kesimpulan: Didapatkan hubungan yang bermakna antara peningkatan kadar hs-CRP pada hari ke-7 dan kadar hari ke-3 dengan fungsi kognitif pasien stroke iskemik akut.Kata kunci: hs-CRP, MoCA-Ina, stroke iskemik akut 


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