Serum biomarkers to predict hemorrhagic transformation and ischemic stroke outcomes in a prospective cohort study

Abstract

Ischemic stroke (IS) remains one of the most frequent causes of death and disability worldwide. Identifying possible prognosis factors for IS outcomes, including hemorrhagic transformation (HT), could improve patients' recovery. This study aimed to investigate the potential prognosis role of non-specific laboratory data at admission and baseline MMP-2 and MMP-9 serum levels in predicting HT risk, discharge, and 3-month follow-up status of IS patients. Data from 150 successive acute cerebral infarction patients were analyzed in a prospective cohort study. The active group included patients who developed HT during hospitalization (55 persons). There were no significant differences in age, gender distribution, time to admission, or time to blood sample collection for MMPs measurement between patients in the active and control groups. IS patients from the active group had a significantly higher rate of AF (atrial fibrillation) in the past (p=0.003), while differences in other factors such as diabetes, hypertension, myocardial infarction, previous stroke, obesity, smoking, and alcohol were not significant. Admission NIHSS score and mRS (modified Rankin Scale) values (at discharge and 90 days) were significantly worse in the active group (p<0.001). Among the analyzed admission laboratory factors (glycemia, lipid profile, coagulation panel, inflammatory reaction parameters, MMP-2, MMP-9), INR presented an inverse correlation, with lower values in the HT cohort (univariate analysis – p=0.01, OR=0.11; multivariate analysis - p=0.03, OR=0.09). Further research on larger cohorts is warranted to determine the specific laboratory biomarkers for predicting hemorrhagic transformation and ischemic stroke outcomes.

Frequency, Severity, Risk Factors, and Outcome of Hemorrhagic Transformation in Anterior and Posterior Stroke

“…The data from the literature are contradictory in this regard. In a prospective cohort study of 150 patients with AIS, 55 experienced HT, but diabetes was not found to be a risk factor for HT [15]. In contrast, other studies found that diabetes mellitus is a risk factor for the development of HT [16][17][18].…”

Poor Prestroke Glycemic Control Increases the Rate of Symptomatic Intracranial Hemorrhage after Mechanical Thrombectomy

“…In ex vivo studies, endothelial cells exposed to prolonged hyperglycemic conditions showed elevated MMP-9 activity, which could be ameliorated by free radical scavengers [ 23 , 24 ]. Moreover, elevated MMP-9 levels have been associated with hemorrhagic conversion after r-tPA or mechanical thrombectomy treatment in stroke patients [ 25 , 26 , 27 ]. Thus, in AIS patients with poorly controlled diabetes, their increased risk of symptomatic hemorrhagic transformation might be explained in part by increased MMP-9 activity, though further studies are needed to confirm this hypothesis and understand its relationships with the time course and mechanisms of effect.…”