Early neurological deterioration in cardiogenic cerebral embolism due to nonvalvular atrial fibrillation: Predisposing factors and clinical implications

Abstract

Purpose The aim of the study was to investigate factors which may predispose patients to early neurological deterioration (END) and explore peripheral biomarkers for the prediction of END in cardiogenic cerebral embolism (CCE) patients. Methods Patients diagnosed with CCE within 24 hr of onset between January 2017 and January 2019 were included in this study. END was defined as an increase of ≥2 on the National Institutes of Health Stroke Scale (NIHSS) or the emergence of new neurological symptoms within 3 days of admission. Binary logistic regression was used to investigate the factors associated with END. Receiver operating characteristic (ROC) curves were then generated to determine the predictive value of the potential biomarkers and the optimal cutoff values. Results Of the 129 (male, 55.81%; mean age 71.85 ± 11.99 years) CCE patients, 55 patients with END were identified. Hemorrhage transformation (HT), coronary heart disease (CHD), diastolic blood pressure, cystatin C levels, NIHSS score, and platelet‐to‐lymphocyte ratio (PLR) at admission were independently associated with END. A peripheral cystatin C level ≥ 1.41 mg/L and a PLR ≥ 132.97 were predictive factors for END in CCE patients. The lymphocyte‐to‐monocyte ratio (LMR) was negatively independently associated with HT, and LMR < 2.31 may predict the occurrence of HT in patients with CCE. Conclusions Of the potential predisposing factors considered, increased cystatin C and PLR were associated with END within 3 days of CCE, and a decreased LMR may have predictive value for HT in CCE patients.

Neutrophil-to-Lymphocyte Ratio and Early Neurological Deterioration in Stroke Patients: A Systematic Review and Meta-Analysis

“…After screening of the remaining 17 studies in full text, three studies without any data on NLR and END, two studies with missing SD data, one study including stroke patients suffering from cancer, one study without a control group, and one review article were excluded. Finally, nine articles were included in our study [15][16][17][18][19][20][21][22][23] (Figure 1).…”

“…By extension, NLR may be a predictor of END in stroke patients. Several studies have found that an elevated NLR is related to the development of END [15][16][17][18][19][20][21][22][23]. In light of the growing emphasis on classifying stroke patients for different levels of monitoring intensity and emergency treatments, we conducted a systematic review of a wide range of clinical studies, with no restrictions on the language or publication date, to analyze the potential of NLR as an END risk predictor.…”

A Systematic Review of Body Fluids Biomarkers Associated With Early Neurological Deterioration Following Acute Ischemic Stroke

“…Another recent research from China furtherly confirmed the essential role of Cystatin C in the END. Patients with cardiogenic cerebral embolism were enrolled in the study, and the results demonstrated Cystatin C was associated with END within 3 days of cardiogenic cerebral embolism ( Cong and Ma, 2021 ). However, this study had several limitations that excluded other types of cerebral infarction and not investigated the potential mechanism deeply.…”

Molecular pathophysiological mechanisms of ischemia/reperfusion injuries after recanalization therapy for acute ischemic stroke

“…The incidence of END varies in different trials, ranging between 13% and one-third of patients [195][196][197][198] but has been reported by some researchers to be as high as 43% [199].…”

“…• Hyperglycemia [198][199][200], which leads to increased concentrations of lactate and acidosis in the penumbral area [201], worsens mitochondrial function in the penumbra [202] and predicts poor outcome [203].…”