Biomarkers — predictors of mortality in patients with ischemic stroke

Abstract

BACKGROUND: Stroke is a global health problem and the second leading cause of death worldwide, with ischemic stroke accounting for the majority of acute cerebrovascular accidents. Predicting outcomes in patients with ischemic stroke is challenging due to the limited prognostic performance of existing models. The lack of reliable and predictive biomarkers of ischemic stroke used in clinical practice provides a rationale for studies to address this issue. AIM: The aim of this study was to identify clinical, demographic, neuroimaging and molecular biomarkers of ischemic stroke associated with the fatal outcome of the disease. MATERIALS AND METHODS: We retrospectively analyzed cases of ischemic stroke confirmed by computed tomography of the brain with a duration of 3 months or less. As factors potentially related to the outcome of ischemic stroke, we considered (1) clinical and demographic characteristics, including sex, age, history of acute cerebrovascular accident, time from stroke to hospitalization, phase and type of stroke, neurological status on admission (level of consciousness, FOUR coma scale), comorbidities (diabetes mellitus, infectious complications, oncological diseases); (2) molecular biomarkers including blood glucose and neuron-specific enolase (NSE) levels at different phases of stroke; (3) neuroimaging biomarkers such as number and location of stroke lesion, total infarct volume, signs of edema, hemorrhagic component according to computed tomography. RESULTS: 38 patients with ischemic stroke were included in the study. Lesion volume was larger in non-survivors: 123 [44.6–206.2] versus 42.7 [8.2–88.7] ml3 (p=0.032), and cerebral edema was detected significantly more often on admission CT scan than in survivors: 7 (77.8%) versus 10 (34.5%), p=0.022. Stroke lesion volume was a predictor of mortality (AUC 0.739; 95% CI 0.542–0.937; p=0.032). The optimal cut-off for stroke lesion volume was found to be 90 ml3. CONCLUSION: Signs of edema/brain stem dislocation and cerebral lesion volume 90 ml3 documented at hospital admission are predictors of fatal outcome. Therefore, neuroimaging biomarkers can be used for risk stratification of fatal outcome in ischemic stroke patients.