RESEARCH PAPER
Clinical and biochemical predictors of late-outcome in patients after ischemic stroke
 
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1
Department of Neurology, Medical University, Lublin, Poland
 
2
Department of Medical Chemistry, Medical University, Lublin, Poland
 
3
Department of Neurosurgery, Medical University, Lublin, Poland
 
4
Institute of Psychology, Marie Curie-Skłodowska University, Lublin, Poland
 
 
Corresponding author
Joanna Ewa Bielewicz   

Department of Neurology, Medical University of Lublin, Poland
 
 
Ann Agric Environ Med. 2020;27(2):290-294
 
KEYWORDS
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ABSTRACT
Objective:
The aim of this study is to evaluate neurological scales, as well as biochemical and radiological parameters measured on day 10 after ischemic stroke (IS), according to their value as predictors of the long-term outcome.

Material and methods:
45 patients were assessed according to the Barthel Index (BI) and National Institute of Health Stroke Scale (NIHSS) on day 10, and according to Modified Rankin Scale (mRS) 3 months after the onset of IS. On day 10 of IS, the serum level of C-reactive protein (CRP), albumin, D-dimers (DD), S100BB and Tau proteins was measured and the volume of ischemic focus assessed with the use of Computed Tomography (CT). The patients were divided into groups with good outcome (GO) and mRS 0–2, and with bad outcome (BO) and mRS 3–6.

Results:
NIHSS and BI scores (p<0.001), the volume of ischemic focus (p<0.01), CRP (p<0.01) and albumin level (p<0.05), but not DD, S100BB and Tau protein levels evaluated on day 10, correlated with mRS after 3 months since IS onset. Patients from the BO group were observed to have lower BI (p=0.001), higher NIHSS (p<0.01) and CRP levels (p<0.05), and bigger volume of ischemic focus (p<0.05) measured on day 10 of IS. In the GO group, there were more patients with atherosclerotic etiology (p=0.02 x2=7.856). Regression analysis showed that only the BI score assessed on day 10 of IS can predict the outcome after 3 months assessed by mRS (OR=1.102, 95%, CI:1.01–1.203; p=0.001).

Conclusions:
BI assessed on day 10 has a predictive value for the outcome evaluated by mRS 3 months after the onset of IS.

 
REFERENCES (40)
1.
Iemolo F, Sanzaro E, Duro G, Giordano A, Paciaroni M. The prognostic value of biomarkers in stroke. Immun Ageing. 2016; 31(13): 19.
 
2.
Memis D, Kozanoglu E, Kelle B, Goncu MK. Assessment of demographic and clinical characteristics on functional status and disability of patients with stroke. Neurosciences (Riyadh). 2016; 21(4): 352–357.
 
3.
Bettger JP, Thomas L, Liang L, Xian Y, Bushnell CD, Saver JL, et al. Hospital variation in functional recovery after stroke. Circ cardiovasc Qual Outcomes. 2017; 10(1).
 
4.
Muir KW, Weir CJ, Murray GD, Povey C, Lees KR. Comparison of neurological scales and scoring systems for acute stroke prognosis. Stroke. 1996; 27(10): 1817–20.
 
5.
Rost NS, Bottle A, Lee JM, Middleton S, Shaw L, Thijs V, et al. Global Comparators Stroke GOAL collaborators. Stroke severity is a crucial predictor of outcome: an international prospective validation study. J Am Heart Assoc. 2016; 21; 5(1).
 
6.
Bhaskar S, Stanwell P, Bivard A, Spratt N, Walker R, Kitsos GH, et al. The initial of stroke severity on mortality overall functional outcome and in-hospital placement at 90 days acute ischemic stroke. A tertiary hospital stroke register study. Neurol India. 2017; 65(6): 1252–1259.
 
7.
Bhatt A, Leslo A, Lucas L, Kansava A, Baraban E, et al. Patients with low National Institutes of Health Stroke Scale Scores have longer door-to-needle times: analysis of a Telestroke Network. J Stroke Cerebrovasc Dis. 2016; 25(9): 2253–8.
 
8.
Young FB, Weir CJ, Lees KR. Comparison of the National Institutes of Health Stroke Scale with disability outcome measures in acute stroke. Stroke. 2005; 36(10): 2187–92.
 
9.
Quinn TJ, Langhorne P, Stott DJ. Barthel Index for Stroke Trials: development, properties and application. Stroke. 2011; 42 (4): 1146–1151.
 
10.
Balu S. Differences in psychometric properties, cut-off scores, and outcomes between the Barthel Index and Modified Rankin Scale in pharmacotherapy-based stroke trials: systemic literature review. Curr Med Res Opin. 2009; 25(6): 1329–41.
 
11.
Kwakkel G, Veerbeek JM, Harmeling-van der Wel BC, van Wegen E, Kollen BJ. Early Prediction of Functional Outcome after Stroke (EPOS) Investigators. Diagnostic accuracy of theBarthel Index for Measuring Activities of Daily Living Outcome After Ischemic Hemispheric Stroke: does early poststroke timing of assessment matter? Stroke. 2011; 42 (92): 342–346.
 
12.
Huybrechts KF, Caro JJ. The Barthel Index and modified Rankin Scale as prognostic tools for long-term outcomes after stroke: a qualitative review of the literature. Curr Med Res Opin. 2007; 23(7): 1627–36.
 
13.
Quinn TJ, Dawson J, Walters MR, Lees KR. Reliability of the Modified Rankin Scale. A systemic review. Stroke 2009; 40(10): 3393–5.
 
14.
Vogt G, Laage R, Shuaib A, Schneider A. VISTA Collaboration. Initial lesion volume is an independent predictor of clinical stroke outcome at day 90: an analysis of the Virtual 10. International Stroke Trials Archive (VISTA) database. Stroke. 2012; 43(5): 1266–72.
 
15.
Pan SL, Wu SC, Wu TH, Lee TK, Chen TH. Location and size of infarct on functional outcome of noncardioembolic ischemic stroke. Disabil Rehabil. 2006; 30; 28(16): 977–83.
 
16.
Zang RS, Zhang H, Xu Y, Zhang SM, Liu X, Wang J et al. Serum C-reactive protein, fibrinogen and D-dimer in patients with progressive cerebral infarction. Transl Neurosci. 2016; 7(1): 84–88.
 
17.
Muir KW, Weir CJ, Alwan W. C-reactive protein and outcome after ischemic stroke. Stroke. 1999; 30(5): 981–5.
 
18.
Welsh P, Barber M, Langhorne P. Associations of inflammatory and haemostatic biomarkers with poor outcome in acute ischaemic stroke. Cerebrovasc Dis. 2009; 27(3): 247–53.
 
19.
Shantikumar S, Grant PJ, Catto AJ, Bamford JM, Carter AM. Elevated C-reactive protein and long-term after ischemic stroke: relationship with markers of endothelial cell and platelet activation. Stroke. 2009; 40(3): 977–9.
 
20.
Idicula TT, Waje-Andreassen U, Brogger J, Naes H, Thomassen L.Serum albumin in ischemic stroke patients: the higher the better. The Bergen Stroke Study. Cerebrovasc Dis. 2009; 28(1): 13–7.
 
21.
Dziedzic T, Słowik A, Szczudlik A. Serum albumin level as a predictor of ischemic stroke outcome. Stroke. 2004; 35(6): e156–8.
 
22.
Haapaniemi E, Tatlisumak T. Is D-dimer helpful in evaluating stroke patients? A systematic review. Acta Neurol Scand. 2009; 119: 141–150.
 
23.
Feinberg WM, Ericson LP, Bruck D, Kittelson J. Hemostatic markers in acute ischemic stroke. Association with stroke type, severity and outcome. Stroke 1996; 27(8):1296–300.
 
24.
Castellanos M, Serena J. Applicability of biomarkers in ischemic stroke. Cerebrovasc. Dis. 2007; 24 Suppl 1: 7–15.
 
25.
Kim SJ, Moon GJ, Bang OY. Biomarkers for stroke. J Stroke. 2013; 15(1): 27–37.
 
26.
Foerch C, Singer OC, Neumann-Haefelin T, du Mesnil de Rochemont R, Steinmetz H, Siter M. Evaluation of serum S100B as a surrogate marker for long-term outcome and infarct volume in acute middle cerebral artery infarction. Arch Neuro. 2005; 62(7): 1130–4.
 
27.
Nash DL, Bellolio MF, Stead LG. S100 as a marker of acute brain ischemia: a systematic review. Neurocrit Care. 2008; 8(2): 301–7.
 
28.
Bitsch A, Horn C, Kemmling Y, Seipelt M, Hellenbrand U, Stefel M. Serum Tau protein level as a marker of axonal damage in acute ischemic stroke. Europ Neurol. 2002; 47: 45–51.
 
29.
Bielewicz J, Kurzepa J, Czekajska-Chehab, Stelmasiak Z, Bartosik-Psujek H. Bielewicz J. Does serum Tau protein predict the outcome of patients with ischemic stroke? J Mol Neurosci. 2011; 43(3): 241–5.
 
30.
Zheng GQ, Wang XM, Wang Y, Wang XT. Tau as a potential novel therapeutic target in ischemic stroke. J Cell Biochem. 2010; 109(1): 26–9.
 
31.
Ovbiagele B, Saver JL. Day-90 acute ischemic stroke outcomes can be derived from early functional activity level. Cerebrovasc Dis. 2010; 29(1): 50–6.
 
32.
Kerr DM, Fulton RL, Lees KR; VISTA Collaborators. Seven-day NIHSS is a sensitive outcome measure for exploratory clinical trials in acute stroke: evidence from the Virtual International Stroke Trials Archive. Stroke 2012; 43(5): 1401–3.
 
33.
Cioncoloni D, Piu P, Tassi R, Acampa M, Guideri F, Taddei S, et al. Relationship between the modified Rankin Scale and the Barthel Index in the process of functional recovery after stroke. Neuro Rehabilitation. 2012; 30(4): 315–22.
 
34.
Matsuo R, Ago T, Hata J, Wakisaka J, Kuroda J, Kuvashiro T, et al.Fukuoka Stroke Registry Investigators. Plasma C-reactive protein and clinical outcomes after acute ischemic stroke. A prospective observational study. PloSone. 2016; 11(6): e0156790.
 
35.
Kuhlmann CR, Librizzi L, Closhen D, Pflanzner T, Lessmann V, Pietrzik CU, et al. Mechanisms of C-reactive protein-induced blood-brain barrier disruption. Stroke. 2009; 40(4): 1458–66.
 
36.
Pepys MB, Hischfield GM, Tennent GA, Gallimore JR, Kahan MC, Bellotti V. Targeting C-reactive protein for treatment of cardiovascular disease. Nature. 2006; 440(7088): 1217–21.
 
37.
Dziedzic T. Systemic inflammation as a therapeutic target in acute ischemic stroke. Expert Rev Neurother. 2015; 15(5): 523–31.
 
38.
Squizzato A, Ageno W, Finazzi S, Mera V, Ranualdi E, Bossi A, et al. D-dimer is not a long-term prognostic marker following acute cerebral ischemia. Blood Coagul Fibrinolysis. 2006; 17(4): 303–6.
 
39.
Sato S, Uehara T, Ohara T, Suzuki R, Toyoda K, Minematsu. Factors associated with unfavorable outcome in minor stroke. Neurology. 2014; 83(2): 174–81.
 
40.
Bentsen L, Christensen A, Christensen H. Outcome and risk factors presented in old patients above 80 years of age versus younger patients after ischemic stroke. J Stroke Cerebrovasc Dis. 2014; (7): 1944–8.
 
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