RESUMO

Stroke is one of the major causes of morbidity and mortality throughout the world. Research is going on to find out the factors which are associated with the severity of acute ischemic stroke. One of the factors which has gained interest in the field of research in recent time is serum ferritin. Serum ferritin is an acute phase reactant. It is recently under research as a marker of severity and prognosis of acute ischemic stroke. The aim of this study was to assess the relation of serum ferritin level with the severity of acute ischemic stroke. This cross-sectional study was conducted in the Department of Medicine in Mymensingh Medical College Hospital, Bangladesh from June 2020 to March 2023. In this study, 323 patients with acute ischemic stroke were enrolled. The severity of neurological disability was evaluated in all participants using National Institute of Health stroke scale (NIHSS) within 48 hours of onset of stroke. Blood was taken for estimation of serum ferritin levels within 48 hours of admission. In this study, mean serum ferritin level was 208.3±161.1 ng/ml in patients with acute ischemic stroke. The study showed most of the participants with high serum ferritin level had severe stroke (n=57, 77.0%; p<0.001). A statistically significant correlation was found between NIHSS and serum ferritin levels in acute ischemic stroke patients (r=0.71). This study revealed that serum ferritin level is associated with severity of neurological disability among patients with acute ischemic stroke. Further studies are required to establish the role of serum ferritin as a prognostic marker of acute ischemic stroke.

Assuntos

Ferritinas , AVC Isquêmico , Índice de Gravidade de Doença , Humanos , Ferritinas/sangue , Masculino , Feminino , Estudos Transversais , Pessoa de Meia-Idade , AVC Isquêmico/sangue , AVC Isquêmico/diagnóstico , AVC Isquêmico/complicações , Idoso , Biomarcadores/sangue , Bangladesh/epidemiologia , Adulto , Prognóstico , Avaliação da Deficiência

RESUMO

Background and purpose:

Dysphagia, characterized by difficulty in swallowing due to neurological deficits, stands out as the foremost contributor to stroke asso­ciated pneumonia (SAP) development. Recent investigations have explored the utility of blood tests, including parameters like neutrophil count, leukocyte count, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and the CRP to albumin ratio (CAR), at the time of admission as potential markers for predicting SAP development. This study is set out to assess predictors of SAP in patients with acute ischemic stroke and dysphagia. 

. Methods:

This retrospective cross-sectio­nal study, conducted at the University of Health Sciences, Neurology Department of Erenkoy Mental Health Neurological Disor­ders in Istanbul, Turkey, between January 2021 and January 2023, assessed 65 indivi­duals with acute ischemic stroke and dysphagia. Excluding specific criteria, clinical and laboratory data were collected. Patients were categorized into SAP and non-SAP groups based on diagnostic criteria. Results provide insights into risk factors of SAP.

. Results:

In this study of 65 stroke patients with dysphagia, 27 (41.5%) developed SAP within the first week. No significant differences in age, gender, comorbidities, or infarct size were observed between the pneumonia-positive and pneumonia-negative groups (p > 0.05). HbA1c levels were significantly lower in the pneumonia-positive group (p = 0.02). Logistic regression revealed that NLR, CAR levels, and the presence of atrial fibrillation (AF) were significant predictors of pneumonia development (p < 0.001).

. Conclusion:

Dysphagia is considered one of the most significant risk factors for SAP. However not all ischemic stroke patients with dysphagia develop SAP; that is the reason we think NLR, CAR, and AF might be predictors of SAP in acute ischemic stroke patients with dysphagia.

.

Assuntos

Transtornos de Deglutição , Pneumonia , Acidente Vascular Cerebral , Humanos , Transtornos de Deglutição/etiologia , Feminino , Masculino , Idoso , Estudos Retrospectivos , Turquia/epidemiologia , Acidente Vascular Cerebral/complicações , Pessoa de Meia-Idade , Pneumonia/complicações , Pneumonia/sangue , Fatores de Risco , AVC Isquêmico/complicações , AVC Isquêmico/sangue , Biomarcadores/sangue , Estudos Transversais

RESUMO

This study aimed to investigate the association between non-traditional lipid profiles and the risk of 1-year vascular events in patients who were already using statins before stroke and had admission LDL-C < 100 mg/dL. This study was an analysis of a prospective, multicenter, nationwide registry of consecutive patients with acute ischemic stroke patients who treated with statin before index stroke and LDL-C < 100 mg/dL on admission. Non-traditional lipid profiles including non-HDL, TC/HDL ratio, LDL/HDL ratio, and TG/HDL ratio were analyzed as a continuous or categorical variable. The primary vascular outcome within one year was a composite of recurrent stroke (either hemorrhagic or ischemic), myocardial infarction (MI) and all-cause mortality. Hazard ratios (95% Cis) for 1-year vascular outcomes were analyzed using the Cox PH model for each non-traditional lipid profiles groups. A total of 7028 patients (age 70.3 ± 10.8years, male 59.8%) were finally analyzed for the study. In unadjusted analysis, no significant associations were observed in the quartiles of LDL/HDL ratio and 1-year primary outcome. However, after adjustment of relevant variables, compared with Q1 of the LDL/HDL ratio, Q4 was significantly associated with increasing the risk of 1-year primary outcome (HR 1.48 [1.19-1.83]). For the LDL/HDL ratio, a linear relationship was observed (P for linearity < 0.001). Higher quartiles of the LDL/HDL ratio were significantly and linearly associated with increasing the risk of 1-year primary vascular outcomes. These findings suggest that even during statin therapy with LDL-C < 100 mg/dl on admission, there should be consideration for residual risk based on the LDL/HDL ratio, following stroke.

Assuntos

LDL-Colesterol , Inibidores de Hidroximetilglutaril-CoA Redutases , AVC Isquêmico , Humanos , Masculino , Feminino , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Idoso , AVC Isquêmico/sangue , AVC Isquêmico/tratamento farmacológico , LDL-Colesterol/sangue , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Idoso de 80 Anos ou mais , Lipídeos/sangue , Sistema de Registros , Infarto do Miocárdio/sangue , Infarto do Miocárdio/tratamento farmacológico , Infarto do Miocárdio/mortalidade , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/tratamento farmacológico

RESUMO

BACKGROUND: Plasma growth differentiation factor 15 (GDF15) and N-terminal proB-type natriuretic peptide (NT-proBNP) are cardiovascular biomarkers that associate with a range of diseases. Epigenetic scores (EpiScores) for GDF15 and NT-proBNP may provide new routes for risk stratification. RESULTS: In the Generation Scotland cohort (N ≥ 16,963), GDF15 levels were associated with incident dementia, ischaemic stroke and type 2 diabetes, whereas NT-proBNP levels were associated with incident ischaemic heart disease, ischaemic stroke and type 2 diabetes (all PFDR < 0.05). Bayesian epigenome-wide association studies (EWAS) identified 12 and 4 DNA methylation (DNAm) CpG sites associated (Posterior Inclusion Probability [PIP] > 95%) with levels of GDF15 and NT-proBNP, respectively. EpiScores for GDF15 and NT-proBNP were trained in a subset of the population. The GDF15 EpiScore replicated protein associations with incident dementia, type 2 diabetes and ischaemic stroke in the Generation Scotland test set (hazard ratios (HR) range 1.36-1.41, PFDR < 0.05). The EpiScore for NT-proBNP replicated the protein association with type 2 diabetes, but failed to replicate an association with ischaemic stroke. EpiScores explained comparable variance in protein levels across both the Generation Scotland test set and the external LBC1936 test cohort (R2 range of 5.7-12.2%). In LBC1936, both EpiScores were associated with indicators of poorer brain health. Neither EpiScore was associated with incident dementia in the LBC1936 population. CONCLUSIONS: EpiScores for serum levels of GDF15 and Nt-proBNP associate with body and brain health traits. These EpiScores are provided as potential tools for disease risk stratification.

Assuntos

Biomarcadores , Metilação de DNA , Diabetes Mellitus Tipo 2 , Fator 15 de Diferenciação de Crescimento , Peptídeo Natriurético Encefálico , Fragmentos de Peptídeos , Humanos , Fator 15 de Diferenciação de Crescimento/sangue , Fator 15 de Diferenciação de Crescimento/genética , Peptídeo Natriurético Encefálico/sangue , Peptídeo Natriurético Encefálico/genética , Fragmentos de Peptídeos/sangue , Fragmentos de Peptídeos/genética , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/genética , Metilação de DNA/genética , Biomarcadores/sangue , Escócia , Demência/sangue , Demência/genética , Epigênese Genética , AVC Isquêmico/sangue , AVC Isquêmico/genética , Teorema de Bayes , Estudos de Coortes

RESUMO

BACKGROUND: In recent years, research on the apolipoprotein E (APOE) gene has gradually proven that many diseases, including atherosclerosis, coronary heart disease, and neurological diseases, are closely related to ApoE gene diversity. However, the relationship between the APOE gene and the prediction and prognosis evaluation of ischemic stroke has not been determined or unified so far. The purpose of this study was to investigate the application value of APOE allele-4 combined with high-resolution vascular wall imaging in predicting the occurrence and prognosis of acute ischemic stroke. METHODS: A total of 511 patients with acute ischemic stroke (AIS), who were admitted from January 2022 to December 2023, were included in the study, including 317 patients with intracranial artery stenosis. Blood lipids, lipoproteins, apolipoprotein E (including allelic typing), and lipoproteins (a) were measured in all cases, and high-resolution magnetic resonance imaging of the vascular walls was performed. At 6 months, the functional outcomes of the AIS patients were followed up, assessed by using the modified Rankin Scale (mRS) (a score of 2 - 6 was rated as poor prognosis), and the high-definition vascular wall imaging results were followed up as well. High-definition vascular wall imaging ensures the accurate location of vascular stenosis and the accurate diagnosis of acute stroke. RESULTS: There were no significant differences in the total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, or lipoprotein (a) in patients with and without intracranial artery stenosis, but the plasma apolipoprotein E (APOE) levels were significantly reduced in patients with intracranial artery stenosis (ICAS). At the 6-month follow-up, 230 patients with the APOE-ε4 gene were enrolled, out of which 104 had a poor prognosis (mRS score ≥ 2), accounting for 45.22%. Among 281 patients without the APOE-ε4 gene, 45 had a poor prognosis (mRS score ≥ 2), accounting for 16.01%. Patients with the APOE-ε4 gene had a worse functional prognosis after 6 months. CONCLUSIONS: It is suggested that low plasma APOE levels may be a high risk factor for ICAS in patients with acute ischemic stroke, and carrying the APOE-ε4 gene may be a high risk factor for a poor functional prognosis in AIS patients. The APOE-ε4 genotype, combined with high-resolution vascular wall imaging, has certain clinical application value in predicting the occurrence of acute ischemic death and evaluating the functional outcome.

Assuntos

AVC Isquêmico , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , AVC Isquêmico/sangue , AVC Isquêmico/diagnóstico , Prognóstico , Idoso , Apolipoproteínas E/genética , Apolipoproteínas E/sangue , Imageamento por Ressonância Magnética/métodos , Isquemia Encefálica/sangue , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/genética , Fatores de Risco

RESUMO

The stress hyperglycemia ratio (SHR) is established as a reliable marker for assessing the severity of stress-induced hyperglycemia. While its effectiveness in managing patients with Acute Ischemic Stroke (AIS) remains to be fully understood. We aim to explore the relationship between SHR and clinical prognosis in AIS patients and to assess how diabetes status influences this relationship. In this study, we analyzed data from the Medical Information Mart for Intensive Care (MIMIC-IV) database, selecting patients with AIS who required ICU admission. These patients were categorized into tertiles based on their SHR levels. We applied Cox hazard regression models and used restricted cubic spline (RCS) curves to investigate relationships between outcomes and SHR. The study enrolled a total of 2029 patients. Cox regression demonstrated that a strong correlation was found between increasing SHR levels and higher all-cause mortality. Patients in the higher two tertiles of SHR experienced significantly elevated 30-day and 90-day mortality rates compared to those in the lowest tertile. This pattern remained consistent regardless of diabetes status. Further, RCS analysis confirmed a progressively increasing risk of all-cause mortality with higher SHR levels. The findings indicate that SHR is association with increased 30-day and 90-day mortality among AIS patients, underscoring its potential value in risk stratification. Although the presence of diabetes may weaken this association, significant correlations persist in diabetic patients.

Assuntos

Hiperglicemia , AVC Isquêmico , Humanos , Masculino , Feminino , Idoso , AVC Isquêmico/mortalidade , AVC Isquêmico/sangue , AVC Isquêmico/complicações , Hiperglicemia/mortalidade , Hiperglicemia/complicações , Hiperglicemia/sangue , Pessoa de Meia-Idade , Prognóstico , Idoso de 80 Anos ou mais , Modelos de Riscos Proporcionais , Glicemia/análise , Fatores de Risco

RESUMO

BACKGROUND AND AIM: Glycated albumin (GA) is a biomarker monitoring glycemia 2-4 weeks before stroke onset. This study was designed to explore the association between GA levels with poststroke outcomes in patients with acute ischemic stroke or transient ischemic attack (TIA). METHOD: Participants with ischemic stroke or TIA who had a baseline GA measurement were included in the Third China National Stroke Registry study. The effect of GA on stroke recurrence, poor functional outcomes, and combined vascular events was examined during the 1-year follow-up period. Multivariate Cox and logistic regression models were performed to evaluate the association. Discrimination tests were used to examine the incremental predictive value of GA when incorporating it into the conventional model. RESULTS: A total of 3861 participants were enrolled. At the 3-month follow-up, the elevated GA level was associated with an increased risk of poor functional outcomes (adjusted odds ratio [OR], 1.45; 95% confidence interval [CI], 1.01-2.09). A similar increase was observed for stroke recurrence (adjusted hazard ratio [HR], 1.56; 95% CI, 1.09-2.24), poor functional outcomes (adjusted OR, 1.62; 95% CI, 1.07-2.45), and combined vascular events (adjusted HR, 1.55; 95% CI, 1.09-2.20) at the 1-year follow-up. In nondiabetic patients, the association between GA and poor functional outcomes was more pronounced (adjusted OR, 1.62; 95% CI, 1.05-2.50). Adding GA into the conventional model resulted in slight improvements in predicting poor functional outcomes (net reclassification improvement [NRI]: 12.30% at 1 year). CONCLUSION: This study demonstrated that elevated GA levels in serum were associated with stroke adverse outcomes, including stroke recurrence, poor functional outcomes, and combined vascular events, in patients with ischemic stroke or TIA.

Assuntos

Biomarcadores , Albumina Sérica Glicada , Produtos Finais de Glicação Avançada , AVC Isquêmico , Albumina Sérica , Humanos , Feminino , Masculino , Produtos Finais de Glicação Avançada/sangue , AVC Isquêmico/sangue , AVC Isquêmico/epidemiologia , China/epidemiologia , Pessoa de Meia-Idade , Idoso , Biomarcadores/sangue , Albumina Sérica/análise , Albumina Sérica/metabolismo , Prognóstico , Ataque Isquêmico Transitório/sangue , Ataque Isquêmico Transitório/epidemiologia , Sistema de Registros , Recidiva , Fatores de Risco , Seguimentos , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/epidemiologia

RESUMO

Regenerating Family Member 3 Alpha (REG3A) is an antimicrobial protein secreted by the intestine and pancreas with additional immunomodulatory properties. Previously, we published that REG3A expression in ischemic stroke patient systemic blood, during mechanical thrombectomy (MT), is significantly associated with inflammatory cytokines and patient function on admission. This paper, however, did not investigate post-acute death rates. Therefore, we investigated plasma REG3A protein expression, during MT, in patients (n = 141) that survived or died within the end of the follow-up after MT. Subjects who died had significantly higher systemic plasma REG3A levels at the time of MT compared to survivors (p = 0.001). Age, sex, time from last known normal, and admission NIHSS were included as predictors to control for confounding variables and were all examined to determine their association in patient mortality. Logistic regression was used to demonstrate that higher odds of death were associated with increased REG3A levels (p = 0.002). REG3A demonstrated acceptable discrimination (AUC (95% CI): 0.669 (0.566-0.772) in predicting mortality. The overall model with age, sex, time from last known normal, and admission NIHSS discriminated well between survivors and those who died (AUC (95% CI): 0.784 (0.703-0.864)). In conclusion, REG3A could be promising as a biomarker to prognosticate stroke outcomes and stratify high-risk groups following acute ischemic stroke.

Assuntos

Proteínas Associadas a Pancreatite , Humanos , Masculino , Feminino , Idoso , Proteínas Associadas a Pancreatite/sangue , Proteínas Associadas a Pancreatite/metabolismo , Pessoa de Meia-Idade , Biomarcadores/sangue , Prognóstico , Idoso de 80 Anos ou mais , AVC Isquêmico/mortalidade , AVC Isquêmico/sangue

RESUMO

We conducted a post hoc analysis of Remote Ischemic Conditioning for Acute Moderate Ischemic Stroke (RICAMIS) to investigate whether red blood cell (RBC) indices are associated with efficacy of remote ischemic conditioning (RIC), and whether the association is affected by age. In this post hoc analysis, patients with RBC indices at admission were enrolled. RBC indices including RBC count, hematocrit (HCT), mean corpuscular volume (MCV), hemoglobin (HB), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) were analyzed. According to the median of these RBC indices, eligible patients were divided into high and low groups, which were further subdivided into RIC and control subgroups. Primary endpoint was excellent functional outcome defined as a modified Rankin Scale score of 0-1 at 90 days, which was used to evaluate RIC efficacy. RIC efficacy as well as effect of age on RIC efficacy were analyzed across the high and low groups of different RBC indices, and the interaction effects of RBC indices on RIC efficacy were evaluated. A total of 1640 patients were enrolled in the final analysis. In overall patients, no significant interaction effects of RIC intervention by all RBC indices were found, although there was a trend in interaction effect of RIC intervention by MCH (p = 0.116). However, we found an effect of age on the association of MCH with RIC efficacy. In patients over 60 years old, MCH significantly affected RIC efficacy (p = 0.006) and RIC significantly produced a higher proportion of primary outcome in high MCH (72.6% vs. 59.1%, P < 0.001) vs. low MCH group (61.2% vs. 62%, P = 0.829), which was not identified in patients under 60 years old. Furthermore, RIC efficacy decreased with increasing age in patients with low MCH with significant interaction effect (p = 0.012), while RIC efficacy increased with increasing age in patients with high MCH although no significant interaction (p = 0.126). No significant interaction effects of RIC intervention by RBC count, HCT, MCV, HB, and MCHC were found regardless of age. This secondary analysis of RICAMIS suggested that RIC exhibited more obvious benefit in AIS patients over 60 years old with high MCH compared with those with low MCH group, but RBC count, HCT, MCV, HB, and MCHC were not associated with the efficacy of RIC treatment regardless of age.

Assuntos

Índices de Eritrócitos , Precondicionamento Isquêmico , AVC Isquêmico , Humanos , Masculino , Idoso , Feminino , Pessoa de Meia-Idade , AVC Isquêmico/sangue , AVC Isquêmico/terapia , Precondicionamento Isquêmico/métodos , Fatores Etários , Resultado do Tratamento , Idoso de 80 Anos ou mais , Eritrócitos

RESUMO

BACKGROUND: Antiphospholipid antibodies (aPLs) have been reported to be involved in platelet-mediated thrombosis and inflammation, but the impact on the prognosis of ischemic stroke remains unclear. We aimed to examine whether the association between baseline platelet count (PLT) and long-term clinical outcomes within 2 years after ischemic stroke onset is modulated by aPLs. METHODS AND RESULTS: A total of 2938 patients with ischemic stroke were included in this prospective cohort study. Cox proportional hazards regression models were used to assess the association between the baseline PLT stratified by aPLs status and 2-year clinical outcomes after stroke onset, and an interaction effect between PLT and aPLs on clinical outcomes was tested by likelihood ratio test. There was a significant interaction effect of aPLs and PLT on recurrent stroke (Pinteraction=0.002) and cardiovascular events (Pinteraction=0.001) within 2 years after stroke onset. After multivariate adjustment, high PLT was associated with increased risks of recurrent stroke (hazard ratio [HR], 2.78 [95% CI, 1.03-7.45]; Ptrend=0.039) and cardiovascular events (HR, 2.58 [95% CI, 1.12-5.90]; Ptrend=0.024) when 2 extreme tertiles were compared among patients with aPL positive, but not among those with aPL negative. CONCLUSIONS: The aPLs had a modifying effect on the association between PLT and clinical outcomes within 2 years after ischemic stroke onset. Increased PLT was associated with recurrent stroke and cardiovascular events after ischemic stroke onset among patients with aPL positive, but not in those with aPL negative.

Assuntos

Anticorpos Antifosfolipídeos , AVC Isquêmico , Recidiva , Humanos , Feminino , Masculino , AVC Isquêmico/sangue , AVC Isquêmico/imunologia , AVC Isquêmico/diagnóstico , Anticorpos Antifosfolipídeos/sangue , Pessoa de Meia-Idade , Estudos Prospectivos , Contagem de Plaquetas , Idoso , Prognóstico , Fatores de Risco , Fatores de Tempo , Medição de Risco , Valor Preditivo dos Testes , Biomarcadores/sangue , Plaquetas/imunologia

RESUMO

Background and Objectives: Acute ischemic stroke (AIS) is a leading cause of death and disability with poor long-term outcomes. Creating a predictive score for long-term mortality in AIS might be important for optimizing treatment strategies. The aim of this study is to develop and validate a predictive score for three-year mortality in patients with AIS using several demographic, clinical, laboratory and imaging parameters. Materials and Methods: This study included 244 AIS patients admitted to a tertiary center and followed up for three years. The patients' data included demographics, clinical features, laboratory tests (including resistin and leptin levels) and imaging parameters. The patients were randomly divided into a predictive group (n = 164) and a validation group (n = 80). Results: Advanced age, a high NIHSS score, low levels of hemoglobin, elevated resistin levels and the presence of carotid plaques were independently associated with three-year mortality. The predictive model incorporated these variables, and it was validated in a separate cohort. Leptin levels did not significantly predict mortality. Conclusions: This study developed and validated a promising predictive score for three-year mortality in patients with AIS. Advanced age, high NIHSS scores, low hemoglobin levels, elevated resistin levels and the presence of carotid plaques were the independent predictors of long-term mortality.

Assuntos

AVC Isquêmico , Resistina , Humanos , Masculino , Feminino , Idoso , AVC Isquêmico/mortalidade , AVC Isquêmico/sangue , Pessoa de Meia-Idade , Resistina/sangue , Valor Preditivo dos Testes , Leptina/sangue , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Biomarcadores/análise

RESUMO

Objective: This study aimed to evaluate the predictive value of IL-6 for stroke recurrence in acute ischemic stroke.Methods: Patients who were admitted within 48 h of onset were included. At 3-month, stroke recurrence was assessed. IL-6 levels were measured in serum samples taken upon admission.Results: Out of the 305 patients, 47 (15.4%) experienced a stroke recurrence. The risk of stroke recurrence increased by 8% (OR: 1.08; 95% CI: 1.04-1.11; p < 0.001) for every 1 pg/ml increase in IL-6 serum level, both in unadjusted and adjusted analyses (6%; OR: 1.06; 95% CI: 1.02-1.10; p = 0.001).Conclusion: The study supports the usefulness of IL-6 as a predictive biomarker for stroke recurrence after acute ischemic stroke.

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[Box: see text].

Assuntos

Biomarcadores , Interleucina-6 , AVC Isquêmico , Recidiva , Humanos , Interleucina-6/sangue , Masculino , Feminino , Idoso , AVC Isquêmico/sangue , AVC Isquêmico/diagnóstico , Biomarcadores/sangue , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/diagnóstico , Isquemia Encefálica/sangue

RESUMO

Aim: To identify novel metabolic biomarkers for patients with acute ischemic stroke (AIS).Methods: The metabolites in the sera of 63 patients with AIS aged 45∼77 years and 60 healthy individuals were analyzed by liquid chromatography (LC)-mass spectrometry (MS)/MS. The efficiency of significantly altered metabolites as biomarkers of AIS was evaluated by ROC curve analysis.Results: Different metabolic profiles were revealed in AIS patients' sera compared with healthy persons. Twelve significantly altered metabolites had an area under the curve (AUC) value >0.80, demonstrating their potential as a biomarker of AIS. Among them, six metabolites are firstly reported to distinguish between AIS patients and healthy individuals.Conclusion: These 12 metabolites can be further researched as potential diagnostic biomarkers of AIS.

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In this study, the serum metabolome of patients with AIS aged 45­77 years were analyzed and the potential biomarkers for AIS diagnosis were identified. Twelve serum compounds were found to be significantly altered and have the ability to distinguish patients with AIS and healthy individuals effectively. Among them, six metabolites were firstly reported to have the potential as biomarkers for AIS diagnosis. These results will contribute to biomarker explorations from blood metabolites to predict AIS in patients from different age groups.

Assuntos

Biomarcadores , AVC Isquêmico , Humanos , Biomarcadores/sangue , Masculino , Pessoa de Meia-Idade , Feminino , AVC Isquêmico/diagnóstico , AVC Isquêmico/sangue , AVC Isquêmico/metabolismo , Idoso , Curva ROC , Cromatografia Líquida/métodos , Metabolômica/métodos , Estudos de Casos e Controles , Espectrometria de Massas em Tandem

RESUMO

Background/Objectives. A Mediterranean diet (MD) has been associated with neuroprotective effects. We aimed to assess the MD's association with stroke prognosis and the potential mediators involved. Methods. Seventy patients with acute anterior circulation ischemic stroke were included. Dietary patterns were evaluated using the MEDAS scale, a food-frequency questionnaire, and a 24 h recall. Circulating biomarkers including insulin resistance (HOMA index), adipokines (resistin, adiponectin, leptin), choline pathway metabolites (TMAO, betaine, choline), and endothelial progenitor cells (EPCs) were measured. Early neurological improvement (ENI) at 24 h, final infarct volume, and functional outcome at 3 months were assessed. Results. Adherence to MD and olive oil consumption were associated with a lower prevalence of diabetes and atherothrombotic stroke, and with lower levels of fasting glycemia, hemoglobinA1C, insulin resistance, and TMAO levels. Monounsaturated fatty acids and oleic acid consumption correlated with lower resistin levels, while olive oil consumption was significantly associated with EPC mobilization. Multivariate analysis showed that higher MD adherence was independently associated with ENI and good functional prognosis at 3 months. EPC mobilization, lower HOMA levels, and lower resistin levels were associated with ENI, a smaller infarct volume, and good functional outcome. Conclusions. MD was associated with better prognosis after ischemic stroke, potentially mediated by lower insulin resistance, increased EPC mobilization, and lower resistin levels, among other factors.

Assuntos

Biomarcadores , Dieta Mediterrânea , Resistência à Insulina , AVC Isquêmico , Azeite de Oliva , Humanos , Masculino , Feminino , AVC Isquêmico/sangue , Idoso , Pessoa de Meia-Idade , Biomarcadores/sangue , Azeite de Oliva/administração & dosagem , Adipocinas/sangue , Células Progenitoras Endoteliais/metabolismo , Prognóstico , Resistina/sangue , Resultado do Tratamento

RESUMO

BACKGROUND: Corin plays important roles in the regulation of blood volume and pressure and cardiac function by activating natriuretic peptide pathway, exerting multiple cardioprotective effects. But the impacts of soluble corin on clinical outcomes after ischemic stroke are unclear. We aimed to investigate the associations between serum soluble corin and long-term clinical outcomes after acute ischemic stroke. METHODS AND RESULTS: We measured the concentrations of serum soluble corin in 3162 participants (2010 men and 1152 women) from the China Antihypertensive Trial in Acute Ischemic Stroke. The clinical outcomes were recurrent stroke, cardiovascular events, all-cause mortality, and unfavorable functional outcome within 24 months after stroke. Risk reclassification for study clinical outcomes of models with soluble corin were evaluated. Serum soluble corin was inversely associated with recurrent stroke, cardiovascular events, and unfavorable functional outcome after ischemic stroke. After adjusting for multiple covariates, each additional SD of log-corin was associated with a 21% (95% CI, 11-30), 16% (95% CI, 6-26), and 12% (95% CI, 3-21) decreased risk for recurrent stroke, cardiovascular events, and unfavorable functional outcome, respectively. Furthermore, the addition of soluble corin to the basic model with conventional risk factors significantly improved risk discrimination for recurrent stroke, cardiovascular events, and the composite outcome of all-cause mortality and cardiovascular events, as shown by C-statistics (all P<0.05). CONCLUSIONS: Serum soluble corin was associated with decreased risks of long-term clinical outcomes, and may be a promising prognostic biomarker for risk stratification in patients with acute ischemic stroke.

Assuntos

Biomarcadores , AVC Isquêmico , Recidiva , Serina Endopeptidases , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , AVC Isquêmico/sangue , AVC Isquêmico/mortalidade , AVC Isquêmico/diagnóstico , Biomarcadores/sangue , Idoso , Serina Endopeptidases/sangue , Prognóstico , China/epidemiologia , Fatores de Risco , Medição de Risco , Fatores de Tempo

RESUMO

INTRODUCTION: Ischemic stroke (IS) is a global health concern, often tied to dyslipidemia and vascular endothelial dysfunction. MicroRNA-34a (miR-34a) was reported to be up-regulated in the blood samples of patients with IS, but the specific role of miR-34a and methylenetetrahydrofolate reductase (MTHFR) in IS remains to be elucidated. METHODS: We studied 143 subjects: 71 IS patients, and 72 healthy controls. Human umbilical vein endothelial cells (HUVECs) were cultured and transfected with a miR-34a mimic, inhibitor, or negative control. The miR-34a expression in serum and HUVECs was quantified via quantitative reverse transcription polymerase chain reaction (qRT-PCR). Viability and apoptosis of HUVECs were assessed using CCK-8 assay and flow cytometry. The expression levels of bcl-2, bax, cyt-c, cleaved caspase 3, MTHFR, and homocysteine were measured by Western blot or enzyme-linked immunosorbent assay (ELISA). The relationship between miR-34a and MTHFR was verified by luciferase reporter assay. The levels of MTHFR and homocysteine in serum were examined by ELISA. RESULTS: MiR-34a expression was increased in IS patients and inhibited viability of HUVECs while promoting their apoptosis. Overexpression of miR-34a up-regulated pro-apoptotic proteins (bax, cyt-c and cleaved caspase 3) and down-regulated anti-apoptotic protein bcl-2 in HUVECs. MTHFR was identified as the downstream target of miR-34a and its expression was reduced by miR-34a overexpression, while homocysteine levels increased. Consistently, MTHFR levels were lower and homocysteine levels were higher in IS patients compared with controls. DISCUSSION: Our results suggest that up-regulated miR-34a plays a role in the pathogenesis of IS, potentially through inhibiting MTHFR expression and increasing homocysteine in endothelial cells. Therefore, miR-34a might be a therapeutic target for IS.

Assuntos

Apoptose , Sobrevivência Celular , Homocisteína , AVC Isquêmico , Metilenotetra-Hidrofolato Redutase (NADPH2) , MicroRNAs , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Homocisteína/sangue , Células Endoteliais da Veia Umbilical Humana/metabolismo , AVC Isquêmico/metabolismo , AVC Isquêmico/sangue , AVC Isquêmico/patologia , Metilenotetra-Hidrofolato Redutase (NADPH2)/metabolismo , Metilenotetra-Hidrofolato Redutase (NADPH2)/genética , MicroRNAs/metabolismo , MicroRNAs/genética

RESUMO

BACKGROUND: As a risk factor of cardiovascular diseases, homocysteine can be effectively lowered by folate. However, the associations of folate and homocysteine levels with the prognosis of ischemic stroke remained unclear. METHODS AND RESULTS: A total of 3530 patients with ischemic stroke were included. Serum folate and homocysteine levels were measured at admission. The primary outcome was composite of death and major disability (modified Rankin Scale score≥3) at 3 months after stroke onset. Univariate and multivariate logistic regression models were used. The mediation effect of homocysteine was examined. During follow-up, 1056 participants developed the primary outcome. In the univariate model, participants in the highest quartile of folate had a 29% (95% CI, 0.58-0.87) decreased risk of primary outcome compared with those in the lowest quartile. After multivariate adjustment, the odds ratio associated with the highest quartile of folate was 0.58 (95% CI, 0.46-0.73) for primary outcome. In contrast, participants in the highest quartile of homocysteine had a 52% (95% CI, 1.24-1.98) increased risk of primary outcome compared with those in the lowest quartile. After multivariate adjustment, the odds ratio associated with highest quartile of homocysteine was 1.57 (95% CI, 1.24-1.98) for primary outcome. In addition, 25.5% of the observed associations between folate and primary outcome was mediated through homocysteine (P=0.012). CONCLUSIONS: High folate levels were associated with low risks of death and major disability among Chinese patients with ischemic stroke, and homocysteine partially mediated the observed potential beneficial role of folate.

Assuntos

Ácido Fólico , Homocisteína , AVC Isquêmico , Humanos , Masculino , Homocisteína/sangue , Ácido Fólico/sangue , Feminino , AVC Isquêmico/sangue , AVC Isquêmico/mortalidade , AVC Isquêmico/epidemiologia , AVC Isquêmico/diagnóstico , Idoso , Pessoa de Meia-Idade , Fatores de Risco , Prognóstico , Biomarcadores/sangue , Medição de Risco , Avaliação da Deficiência , China/epidemiologia

RESUMO

The hemojuvelin-hepcidin regulatory axis may play a key role in the iron metabolism both systemically and locally. There is a pressing need to evaluate this tightly regulated network of iron parameters and their potential impact on the development of ischemic stroke (IS). We aimed to assess iron metabolism biomarkers in patients after IS, evaluating changes over time and considering their clinical features. We studied 45 patients diagnosed with IS. We assessed major iron metabolism parameters, such as hepcidin, soluble hemojuvelin (sHJV), soluble transferrin receptor (sTfR), and ferritin, using immunoenzymathic methods at two time points: on admission and on the 7th day post IS. We found increased ferritin levels on the 7th day post IS compared to admission, and this was observed in the entire study group (p = 0.03) and in the subgroup treated with thrombolysis (p = 0.02). The hepcidin levels, on the other hand, showed a significant decrease on the 7th day, though this difference was only evident in the entire study group (p = 0.04). We also discovered significantly elevated sHJV levels in patients with PACI stroke compared to other stroke locations, both on admission and on the 7th day post IS (p < 0.05). Significantly higher sHJV levels were observed in patients treated with thrombolysis compared to those receiving conventional treatment, regardless of the time point (p < 0.0001 and p = 0.0002, respectively). Our study revealed changes in the iron metabolism parameters during stroke. The patients with anterior cerebral infarction and those treated with thrombolysis presented significantly elevated sHJV levels.

Assuntos

Biomarcadores , Proteínas Ligadas por GPI , Proteína da Hemocromatose , Hepcidinas , Ferro , AVC Isquêmico , Receptores da Transferrina , Humanos , Ferro/metabolismo , Ferro/sangue , Masculino , Feminino , AVC Isquêmico/metabolismo , AVC Isquêmico/sangue , Idoso , Hepcidinas/metabolismo , Hepcidinas/sangue , Proteína da Hemocromatose/metabolismo , Proteína da Hemocromatose/genética , Estudos Prospectivos , Pessoa de Meia-Idade , Receptores da Transferrina/metabolismo , Proteínas Ligadas por GPI/metabolismo , Proteínas Ligadas por GPI/sangue , Ferritinas/sangue , Ferritinas/metabolismo , Idoso de 80 Anos ou mais

RESUMO

BACKGROUND: Carotid artery dissection is an important cause of stroke. However, the predictors of ischemic stroke in patients with carotid artery dissection are controversial. The study aimed to analyze the predictors of ischemic stroke in patients with carotid artery dissection through retrospective medical records. METHODS: Data of discharged patients diagnosed with carotid artery dissection during 2019-2023 were retrospectively collected. Based on the occurrence of ischemic stroke, the patients were divided into the ischemic stroke or non-ischemic stroke groups. Based on the results of univariate analyses, variables with an associated P value < 0.05 were introduced into the multivariable logistic regression analysis. . RESULTS: A total of 165 patients were included in the study, with an average age of 55.00 (48.00, 66.00) years, including 86 patients with internal carotid artery dissection and 79 patients with vertebral artery dissection. Ischemic stroke occurred in 69 patients with carotid artery dissection. Multivariate logistic regression analysis indicated that diabetes (odds ratio [OR]: 3.144, 95% confidence interval [CI]: 1.552-6.508, P<0.002) and high white blood cells count (OR: 1.157, 95% CI: 1.02-1.327,P = 0.028) were related to the incidence of ischemic stroke in patients with carotid artery dissection. CONCLUSION: Ischemic stroke caused by carotid artery dissection causes severe damage to the nervous system. This study found that diabetes and high white blood cells count were associated with the incidence of ischemic stroke in patients with carotid artery dissection. Therefore, monitoring and controlling blood glucose levels and infections is essential in patients with carotid artery dissection to reduce the incidence of stroke.

Assuntos

Dissecação da Artéria Carótida Interna , Diabetes Mellitus , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Estudos Retrospectivos , Contagem de Leucócitos/métodos , Dissecação da Artéria Carótida Interna/epidemiologia , Dissecação da Artéria Carótida Interna/complicações , Diabetes Mellitus/epidemiologia , AVC Isquêmico/epidemiologia , AVC Isquêmico/sangue , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Fatores de Risco

RESUMO

OBJECTIVE: The aim of this study was to evaluate the role of the prognostic nutritional index in predicting in-hospital mortality among patients with acute ischemic stroke. METHODS: This retrospective, observational study included patients diagnosed with acute ischemic stroke at the emergency department of the hospital between January 1, 2022, and January 1, 2023. Demographic data, vital parameters, comorbidities, stroke interventions, and laboratory data were collected from electronic medical records. Prognostic nutritional index was calculated using serum albumin levels and a total lymphocyte count. The primary outcome was in-hospital mortality. RESULTS: The study included 176 patients, divided into survivor (93.2%, n=164) and deceased (6.8%, n=12) groups. No significant differences were observed in age, gender, blood pressure, heart rate, or body temperature between the groups. Atrial fibrillation was significantly more common in the deceased group (50%) compared to the survivor group (18.9%) (p=0.011). The median lymphocyte count was significantly higher in the survivor group (1,353 [interquartile range, IQR 984-1,968]/mm³) compared to the deceased group (660 [IQR 462-1,188]/mm³) (p=0.009). The median albumin level was significantly lower in the deceased group (3.31 [IQR 2.67-3.4] g/dL) compared to the survivor group (3.74 [IQR 3.39-4.21] g/dL) (p<0.001). The median prognostic nutritional index was significantly higher in the survivor group (46.05 [IQR 39.1-51.3]) compared to the deceased group (36.7 [IQR 28.7-40.5]) (p<0.001). The area under the receiver operating characteristic for prognostic nutritional index predicting mortality was 0.791 (95%CI 0.723-0.848) (p=0.0002), with a cut-off value of ≤41.92 providing the highest diagnostic accuracy. CONCLUSIONS: Prognostic nutritional index is a valuable prognostic indicator for in-hospital mortality in acute ischemic stroke patients. Low prognostic nutritional index values are associated with increased mortality risk. Incorporating prognostic nutritional index into clinical practice may aid in the early identification of high-risk patients and the optimization of treatment strategies. Further research is needed to validate these findings and explore the broader clinical applications of prognostic nutritional index.

Assuntos

Mortalidade Hospitalar , Avaliação Nutricional , Humanos , Feminino , Masculino , Estudos Retrospectivos , Prognóstico , Idoso , Pessoa de Meia-Idade , Contagem de Linfócitos , Albumina Sérica/análise , Fatores de Risco , Idoso de 80 Anos ou mais , AVC Isquêmico/mortalidade , AVC Isquêmico/sangue , Acidente Vascular Cerebral/mortalidade , Valor Preditivo dos Testes , Estado Nutricional/fisiologia , Curva ROC