Zihan Chang1, Haiqiang Zou2, Zhenchao Xie1, Bin Deng1, Rongfang Que1, Zifeng Huang1, Guomei Weng3, Zhihuan Wu3, Ying Pan4, Yanping Wang4, Mengyan Li5, Huifang Xie1, Shuzhen Zhu1, Li Xiong6, Vincent Ct Mok6, Kunlin Jin7, Midori A Yenari8, Xiaobo Wei1, Qing Wang1. 1. Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangzhou, 510282, China. 2. Department of Neurology, General Hospital of Southern Theatre Command of PLA, Guangzhou, 510010, China. 3. Department of Neurology, 1st People Hospital of Zhaoqing, Zhaoqing, Guangdong, 510000, China. 4. Department of Neurology, the 2nd Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, China. 5. Department of Neurology, Guangzhou First People's Hospital, Guangzhou, 510180, China. 6. Gerald Choa Neuroscience Centre, Department of Medicine and Therapeutics, Faculty of Medicine, Prince of Wales hospital, The Chinese University of Hong Kong, Hong Kong SAR, China. 7. Department of Neurology, University of North Texas Health Science Center, Fort Worth, TX, 76107, USA. 8. Department of Neurology, University of California, San Francisco & the San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.
Abstract
BACKGROUND: This study is to explore whether Cystatin C could be used as a potential predictor of the clinical outcomes in acute ischemic stroke patients treated by intravenous tissue plasminogen activator. METHODS: We performed an observational study with a retrospective analysis of data from 125 acute ischemic stroke patients with intravenous thrombolysis. General linear models were applied to assess Cystatin C levels between groups with different outcomes; logistic regression analysis and receiver operating characteristic curves were adopted to identify the association between Cystatin C and the therapeutic effects. RESULTS: Compared with the Good&Sustained Benefit group (≥4 reduction in National Institutes of Health Stroke Scale or a score of 0-1 at 24 hours and 7 days) and the Good Functional Outcome group (modified Rankin Scale 0-2 at 90 days), serum Cystatin C baseline levels were increased in the non-Good&Sustained Benefit and non-Good Functional Outcome groups. Logistic regression analysis found that Cystatin C was an independent negative prognostic factor for Good&Sustained Benefit (odds ratio = 0.010, p = 0.005) and Good Functional Outcome (odds ratio = 0.011, p = 0.021) after adjustment for potential influencing factors. Receiver operating characteristic curves showed the Cystatin C-involved combined models provided credible efficacy for predicting post-90-day favorable clinical outcomes (area under the curve = 0.86, p < 0.001). CONCLUSIONS: Elevated serum Cystatin C is independently associated with unfavorable clinical outcomes after intravenous tissue plasminogen activator therapy in acute ischemic stroke. Our findings provide new insights into discovering potential mediators for neuropathological process or treatment in stroke. This article is protected by copyright. All rights reserved.
BACKGROUND: This study is to explore whether Cystatin C could be used as a potential predictor of the clinical outcomes in acute ischemic strokepatients treated by intravenous tissue plasminogen activator. METHODS: We performed an observational study with a retrospective analysis of data from 125 acute ischemic strokepatients with intravenous thrombolysis. General linear models were applied to assess Cystatin C levels between groups with different outcomes; logistic regression analysis and receiver operating characteristic curves were adopted to identify the association between Cystatin C and the therapeutic effects. RESULTS: Compared with the Good&Sustained Benefit group (≥4 reduction in National Institutes of Health Stroke Scale or a score of 0-1 at 24 hours and 7 days) and the Good Functional Outcome group (modified Rankin Scale 0-2 at 90 days), serum Cystatin C baseline levels were increased in the non-Good&Sustained Benefit and non-Good Functional Outcome groups. Logistic regression analysis found that Cystatin C was an independent negative prognostic factor for Good&Sustained Benefit (odds ratio = 0.010, p = 0.005) and Good Functional Outcome (odds ratio = 0.011, p = 0.021) after adjustment for potential influencing factors. Receiver operating characteristic curves showed the Cystatin C-involved combined models provided credible efficacy for predicting post-90-day favorable clinical outcomes (area under the curve = 0.86, p < 0.001). CONCLUSIONS: Elevated serum Cystatin C is independently associated with unfavorable clinical outcomes after intravenous tissue plasminogen activator therapy in acute ischemic stroke. Our findings provide new insights into discovering potential mediators for neuropathological process or treatment in stroke. This article is protected by copyright. All rights reserved.