Leonardo Lorente1, María M Martín2, Antonia Pérez-Cejas3, Agustín F González-Rivero4, Rafael Sabatel5, Luis Ramos6, Mónica Argueso7, Jordi Solé-Violán8, Juan J Cáceres9, Alejandro Jiménez10, Victor García-Marín11. 1. Intensive Care Unit, Hospital Universitario de Canarias, Ofra s/n, 38320 La Laguna, Santa Cruz de Tenerife, Spain. 2. Intensive Care Unit, Hospital Universitario Nuestra Señora de Candelaria, Crta del Rosario s/n., 38010 Santa Cruz de Tenerife, Spain. 3. Laboratory Department, Hospital Universitario de Canarias, Ofra, s/n., 38320 La Laguna, Tenerife, Spain. 4. Laboratory Department, Hospital Universitario de Canarias, Ofra, s/n, 38320 La Laguna, Santa Cruz de Tenerife, Spain. 5. Department of Radiology, Hospital Universitario de Canarias, Ofra, s/n, 38320 La Laguna Santa Cruz de Tenerife, Spain. 6. Intensive Care Unit, Hospital General La Palma, Buenavista de Arriba s/n, 38713 Breña Alta, La Palma, Spain. 7. Intensive Care Unit, Hospital Clínico Universitario de Valencia, Avda. Blasco Ibáñez nº17-19, 46004 Valencia, Spain. 8. Intensive Care Unit, Hospital Universitario Dr. Negrín, CIBERES, Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain. 9. Intensive Care Unit, Hospital Insular, Plaza Dr. Pasteur s/n, 35016 Las Palmas de Gran Canaria, Spain. 10. Research Unit, Hospital Universitario de Canarias, Ofra s/n, 38320 La Laguna, Santa Cruz de Tenerife, Spain. 11. Department of Neurosurgery, Hospital Universitario de Canarias, Ofra, s/n, 38320 La Laguna, Santa Cruz de Tenerife, Spain.
Abstract
OBJECTIVE: Caspase-cleaved cytokeratin (CCCK)-18 could appear in blood during apoptosis. In two different studies, on day 1 of cerebral infarction and at 72 hours of cerebral infarction, respectively, higher circulating CCCK-18 levels were found in non-surviving than in surviving patients. The objective of this study was to analyze the ability of these levels to predict mortality at any time during the first week of cerebral infarction. METHODS: Patients with malignant middle cerebral artery infarction (MMCAI) were included and the diagnosis criteria were the presence, observed in a computed tomography, of an acute cerebral infarction in at least 50% of this territory and midline shift, and an acute neurological deterioration with a Glasgow Coma Scale ≤ 8. Serum CCCK-18 levels at days 1, 4 and 8 of MMCAI were determined. RESULTS: Serum concentrations of CCCK-18 at days 1, 4 and 8 of MMCAI were higher in non-surviving (n = 34) than in surviving patients (n = 34). Serum CCCK-18 concentrations at days 1, 4 and 8 of MMCAI had an area under curve (95% CI) used to predict a 30-day mortality of 0.83 (0.72--0.91; p < 0.001), 0.78 (0.65-0.89; p < 0.001) and 0.82 (0.68-0.92; p < 0.001). CONCLUSIONS: The novel finding is that serum levels of CCCK-18 levels at any time after the first week of MMCAI could help predict 30-day mortality.
OBJECTIVE: Caspase-cleaved cytokeratin (CCCK)-18 could appear in blood during apoptosis. In two different studies, on day 1 of cerebral infarction and at 72 hours of cerebral infarction, respectively, higher circulating CCCK-18 levels were found in non-surviving than in surviving patients. The objective of this study was to analyze the ability of these levels to predict mortality at any time during the first week of cerebral infarction. METHODS:Patients with malignant middle cerebral artery infarction (MMCAI) were included and the diagnosis criteria were the presence, observed in a computed tomography, of an acute cerebral infarction in at least 50% of this territory and midline shift, and an acute neurological deterioration with a Glasgow Coma Scale ≤ 8. Serum CCCK-18 levels at days 1, 4 and 8 of MMCAI were determined. RESULTS: Serum concentrations of CCCK-18 at days 1, 4 and 8 of MMCAI were higher in non-surviving (n = 34) than in surviving patients (n = 34). Serum CCCK-18 concentrations at days 1, 4 and 8 of MMCAI had an area under curve (95% CI) used to predict a 30-day mortality of 0.83 (0.72--0.91; p < 0.001), 0.78 (0.65-0.89; p < 0.001) and 0.82 (0.68-0.92; p < 0.001). CONCLUSIONS: The novel finding is that serum levels of CCCK-18 levels at any time after the first week of MMCAI could help predict 30-day mortality.