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PROGNOSTIC BIOMARKERS IN PATIENTS WITH ISCHEMIC STROKE WHO RECEIVED THROMBOLYTIC THERAPY.
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- Author(s): Fjodorovs, Aleksandrs
- Source:
Proceedings of the International Scientific Conference of Daugavpils University / Daugavpils Universitates Starptautiskas Zinatniskas Konferences Materiali; 2017, Issue 59, p174-181, 8p- Subject Terms:
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- Abstract: Introduction. Ischemic stroke is one of the most common cause of death and functional disability across the world. Endovascular mechanical thrombectomy and intravenous thrombolysis with alteplase are the only effective treatment approaches for acute ischemic stroke. Brain ischemia is a complicated biochemical process. Several biomarkers are released during ischemic stroke and they are associated with direct cell damage, blood-brain barrier disruption and inflammatory response. Serum biomarkers evaluation may provide information about stroke severity, pathogenesis and therapeutic benefits. Aim. The aim of the research was to evaluate the association between C-Reactive protein (CRP), troponin I, d-dimer, creatinine, glucose, glomerular filtration rate (GFR) and low density lipoprotein cholesterol (LDL-C) levels at the admission and the results of thrombolytic therapy. Materials and methods. 113 patients who underwent thrombolytic therapy for acute ischemic stroke in Pauls Stradins Clinical University Hospital from 01.01.2015 till 01.01.2016 were studied retrospecively. Blood samples were collected in the emergency department. Neurological status was estimated using the National Institute of Health Stroke Scale (NIHSS). The efficacy of thrombolytic therapy was assessed by comparing NIHSS score at the admission and after treatment. Afterward all patients were divided into three groups - the major improvement (NIHSS>4), minor improvement (NIHSS ≤4) and without any clinical effect. Results. Only the median levels of GFR were significantly (p=0.015) lower in patients who didn't have any clinical improvements after thrombolytic therapy as compared to patients with the major or minor improvements (60.0, interquartile range [IQR] 42.4-72.3 ml/min/1.73m2; 83.2, IQR 65.3-98.3 ml/min/1.73m2 and 75.9, IQR 59.2-94.6 ml/min/1.73m2). Based on the receiver operating characteristic (ROC) curve, the optimal cut-off value of GFR level as an indicator for prediction of worsen clinical outcome after thrombolytic therapy was projected to be 61.65 ml/min/1.73m2, which yielded a sensitivity of 71.4% and a specificity of 24.5%, the area under the curve was 0.788 (95% confidence interval [CI], 0.648-0.928). According Spearman rank correlation test was founded statistically significant indirect correlation between GFR level and NIHSS score after treatment (r=- 0.410, p=0.020) in patients with severe stroke (NIHSS >14). Conclusion. GFR level lower than 61.65 ml/min/1.73m2 at the admission could be predict a worse outcome, especially in patients with severe stroke. [ABSTRACT FROM AUTHOR]
- Abstract: Ievads. Išēmisks insults ir viens no vadošajiem nāves un invaliditātes cēloņiem pasaulē. Vienīga efektīvā insulta ārstēšana ir reperfūzijas terapija, izmantojot intravenozo trombolīzi ar alteplāzi pirmo 4.5 stundu laikā vai arī endovaskulāru trombektomiju. Galvas smadzeņu išēmija ir komplicēts bioķīmisks process. Išēmijas laikā izdalās vairāki biomarķieri, kas ir saistīti ar tiešu šūnu bojājumu, hematoencefāliskās barjeras bojājumu un iekaisuma reakciju. Šo biomarķieru noteikšana dod iespēju noteikt insulta smagumu, patoģenēzi, kā arī paredzēt trombolītiskās terapijas ieguvumu. Mērķis. Pētījuma mērķis bija novērtēt C-reaktīva olbaltuma (CRO), troponīna I, d-dimēru, kreatinīna, glikozes, glomerulāras filtrācijas ātruma (GFĀ) un zema blīvuma lipoporoteīnu holesterīna (ZBLH) līmeņa saistību ar trombolītiskas terapijas efektivitāti. Materiāli un metodes. Pētījumā kopumā tika iekļauti 113 pacienti, kuri saņēma intravenozas trombolīzes terapiju Paula Stradiņa klīniskas universitātes slimnīcā (PSKUS) neiroloģijas nodaļā laika periodā no 01.01.2015 līdz 01.01.2016. Asins analīzes tika paņemtas uzņemšanas nodaļā. Pacientu neiroloģisks statuss tika novērtēts, izmantojot Nacionālas Veselības Institūta Insulta Skalu (National Institute of Health Stroke scale - NIHSS). Trombolīzes efektivitāte tika noteikta salīdzīnot NIHSS vērtību pirms un pēc saņemtas trombolītiskas terapijas. Atbilstoši klīniskam efektam visi pacienti tika sadalīti trīs grupās - pacienti ar būtisku uzlabošanās (NIHSS>4), ar minimālu uzlabošanās (NIHSS≤4) un pacienti bez jebkāda klīniska efekta. Rezultāti. Veicot datu statistisku analīzi, tika noteikts, ka GFĀ mediānas vērtība bija nozīmīgi mazāka pacientiem, kuriem pēc intravenozas trombolīzes nenovēroja nekādu klīnisku efektu, salīdzīnot ar tiem pacientiem, kuriem novēroja būtisku vai minimālu uzlabošanās (60.0, starpkvartiļu izklede [SKI] 42.4-72.3 ml/min/1.73m2; 83.2, SKI 65.3-98.3 ml/min/1.73m2 un 75.9, SKI 59.2-94.6 ml/min/1.73m2, p<0.05). Pamatojoties uz ROC līknes analīzi GFĀ <61.65 ml/min/1.73m2 iestāšanās brīdī ar 71.4% jutīgumu un 24.5% specifiskumu norāda uz samazinātu trombolīzes terapijas efektivitāti. Atbilstoši Spīrmena rangu korelācijas analīzi tika atrasta statistiski nozīmīga korelācija starp GFĀ līmeni un NIHSS vērtību pēc saņemtas trombolīzes (r=-0.410, p=0.020) pacientiem ar smagu išēmisku insultu (NIHSS>14). Secinājumi. GFĀ <61.65 ml/min/1.73m2 iestāšanās brīdī varētu būt izmantojams kā slikts prognostisks rādītājs pirms trombolītiskas terapijas, it īpaši pacientiem ar smagu išēmisku insultu. [ABSTRACT FROM AUTHOR]
- Abstract: Copyright of Proceedings of the International Scientific Conference of Daugavpils University / Daugavpils Universitates Starptautiskas Zinatniskas Konferences Materiali is the property of Daugavpils University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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