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.

Keywords: AF: atrial fibrillation; CRP: C-reactive protein; CT: computed tomography; HDL: high-density lipoprotein; HT: hemorrhagic transformation; INR; INR: International Normalised Ration; IS: ischemic stroke; LDL: low-density lipoprotein; MMP-2; MMP-9; MMPs: matrix metalloproteinases; MRI: magnetic resonance imaging; NIHSS: National Institutes of Health Stroke Scale; NLR: neutrophils to lymphocytes ratio; TJPs: tight junction proteins; biomarkers; hemorrhagic transformation; ischemic stroke prognosis; mRS: modified Rankin scale.