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Current Neurovascular Research

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ISSN (Print): 1567-2026
ISSN (Online): 1875-5739

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Research Article

Prognostic Value of Cystatin C in Acute Ischemic Stroke Patients with Intravenous Thrombolysis

Author(s): Jijun Shi, Chunyuan Zhang, Yongjun Cao*, Xinyuan Qu, Huihui Liu and Shoujiang You

Volume 16, Issue 4, 2019

Page: [301 - 309] Pages: 9

DOI: 10.2174/1567202616666190906110204

Price: $65

Abstract

Background: Less is known about the prognostic value of serum cystatin C in acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT). The aim of the present study was to examine the association between serum cystatin C levels and prognosis of AIS patients after IVT.

Methods: Serum cystatin C was measured within 24 hours after recombinant tissue plasminogen activator (rt-PA) treatment in 280 consecutively recruited patients with AIS. The main outcomes included combination of death and major disability, death, major disability (modified Rankin Scale score 3-5) and vascular events at 3-month follow-up.

Results: During the 3-month follow-up, 94 patients (33.6%) experienced death or major disability (28 deaths and 66 major disability) and 49 patients (17.5%) experienced vascular events. After multivariate adjustment, serum cystatin C was significantly associated with an increased risk of the combined outcome of death and major disability (OR=4.51, P = 0.006). Adding serum cystatin C quartiles to a model containing conventional risk factors improved the predictive power for the combined outcome of death and major disability (continuous net reclassification index 43.88%, P < 0.001; categorical net reclassification index 9.15%, P = 0.013; integrated discrimination improvement 2.31%, P = 0.025). Similar phenomena were also observed in major disability and vascular events.

Conclusion: Higher levels of serum cystatin C in AIS patients after IVT were independently associated with increased risks of poor functional outcomes and vascular events, especially combining conventional risk factors, suggesting that serum cystatin C might improve risk prediction for poor prognosis in AIS patients receiving rt-PA treatment.

Keywords: Cystatin C, acute ischemic stroke, intravenous thrombolysis, prognosis, cystatin, inflammation.

« Previous Next »
[1]
Wang H, Naghavi M, Allen C, et al. GBD 2015 Mortality and causes of death collaborators. global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: A systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388(10053): 1459-544.
[http://dx.doi.org/10.1016/S0140-6736(16)31012-1] [PMID: 27733281]
[2]
Powers WJ, Rabinstein AA, Ackerson T, et al. American Heart Association Stroke Council. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2018; 49(3): e46-e110.
[http://dx.doi.org/10.1161/STR.0000000000000158] [PMID: 29367334]
[3]
Dong Q, Dong Y, Liu L, et al. The Chinese stroke association scientific statement: Intravenous thrombolysis in acute ischaemic stroke. Stroke Vasc Neurol 2017; 2(3): 147-59.
[http://dx.doi.org/10.1136/svn-2017-000074] [PMID: 28989804]
[4]
Chamorro Á, Dirnagl U, Urra X, Planas AM. Neuroprotection in acute stroke: Targeting excitotoxicity, oxidative and nitrosative stress, and inflammation. Lancet Neurol 2016; 15(8): 869-81.
[http://dx.doi.org/10.1016/S1474-4422(16)00114-9] [PMID: 27180033]
[5]
Ni L, Lü J, Hou LB, et al. Cystatin C, associated with hemorrhagic and ischemic stroke, is a strong predictor of the risk of cardiovascular events and death in Chinese. Stroke 2007; 38(12): 3287-8.
[http://dx.doi.org/10.1161/STROKEAHA.107.489625] [PMID: 17947596]
[6]
Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004; 351(13): 1296-305.
[http://dx.doi.org/10.1056/NEJMoa041031] [PMID: 15385656]
[7]
Yahalom G, Schwartz R, Schwammenthal Y, et al. Chronic kidney disease and clinical outcome in patients with acute stroke. Stroke 2009; 40(4): 1296-303.
[http://dx.doi.org/10.1161/STROKEAHA.108.520882] [PMID: 19182072]
[8]
Abrahamson M, Olafsson I, Palsdottir A, et al. Structure and expression of the human cystatin C gene. Biochem J 1990; 268(2): 287-94.
[http://dx.doi.org/10.1042/bj2680287] [PMID: 2363674]
[9]
Dharnidharka VR, Kwon C, Stevens G. Serum cystatin C is superior to serum creatinine as a marker of kidney function: A meta-analysis. Am J Kidney Dis 2002; 40(2): 221-6.
[http://dx.doi.org/10.1053/ajkd.2002.34487] [PMID: 12148093]
[10]
Lee M, Saver JL, Huang WH, et al. Impact of elevated cystatin C level on cardiovascular disease risk in predominantly high cardiovascular risk populations: A meta-analysis. Circ Cardiovasc Qual Outcomes 2010; 3(6): 675-83. [https://www.ncbi.nlm.nih.gov/pubmed/20923994 [20923994]
[11]
Aoki J, Kimura K, Shibazaki K, et al. The susceptibility vessel sign at the proximal M1: A strong predictor for poor outcome after intravenous thrombolysis. J Neurol Sci 2015; 348(1-2): 195-200.
[http://dx.doi.org/10.1016/j.jns.2014.12.002] [PMID: 25529923]
[12]
Jung JM, Kim HJ, Ahn H, et al. Chronic kidney disease and intravenous thrombolysis in acute stroke: A systematic review and meta-analysis. J Neurol Sci 2015; 358(1-2): 345-50.
[http://dx.doi.org/10.1016/j.jns.2015.09.353] [PMID: 26434615]
[13]
Naganuma M, Koga M, Shiokawa Y, et al. Reduced estimated glomerular filtration rate is associated with stroke outcome after intravenous rt-PA: The Stroke Acute Management with Urgent Risk-Factor Assessment and Improvement (SAMURAI) rt-PA registry. Cerebrovasc Dis 2011; 31(2): 123-9.
[http://dx.doi.org/10.1159/000321516] [PMID: 21088392]
[14]
Hao Z, Wu B, Lin S, et al. Association between renal function and clinical outcome in patients with acute stroke. Eur Neurol 2010; 63(4): 237-42.
[http://dx.doi.org/10.1159/000285165] [PMID: 20332640]
[15]
Carr SJ, Wang X, Olavarria VV, et al. Influence of renal impairment on outcome for thrombolysis-treated acute ischemic stroke: ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study) post hoc analysis. Stroke 2017; 48(9): 2605-9.
[http://dx.doi.org/10.1161/STROKEAHA.117.017808] [PMID: 28739832]
[16]
Hao Z, Yang C, Liu M, Wu B. Renal dysfunction and thrombolytic therapy in patients with acute ischemic stroke: A systematic review and meta-analysis. Medicine (Baltimore) 2014; 93(28)e286
[http://dx.doi.org/10.1097/MD.0000000000000286] [PMID: 25526464]
[17]
Ford I, Bezlyak V, Stott DJ, et al. Reduced glomerular filtration rate and its association with clinical outcome in older patients at risk of vascular events: Secondary analysis. PLoS Med 2009; 6(1)e16
[http://dx.doi.org/10.1371/journal.pmed.1000016] [PMID: 19166266]
[18]
Hsiao YJ, Tsai YT, Tsai LK, Fang CW. Idarucizumab-facilitated intravenous thrombolysis in acute ischemic stroke: A therapeutic strategy requiring further investigation. J Neurol Sci 2018; 394: 144-5.
[http://dx.doi.org/10.1016/j.jns.2018.09.017] [PMID: 30266415]
[19]
Zorrilla-Vaca A, Ziai W, Connolly ES Jr, Geocadin R, Thompson R, Rivera-Lara L. Acute kidney injury following acute ischemic stroke and intracerebral hemorrhage: A meta-analysis of prevalence rate and mortality risk. Cerebrovasc Dis 2018; 45(1-2): 1-9.
[http://dx.doi.org/10.1159/000479338] [PMID: 29176313]
[20]
Wang IK, Liu CH, Yen TH, et al. Taiwan Stroke Registry Investigators. Renal function is associated with 1-month and 1-year mortality in patients with ischemic stroke. Atherosclerosis 2018; 269: 288-93.
[http://dx.doi.org/10.1016/j.atherosclerosis.2017.11.029] [PMID: 29254692]
[21]
Ovbiagele B, Smith EE, Schwamm LH, et al. Chronic kidney disease and bleeding complications after intravenous thrombolytic therapy for acute ischemic stroke. Circ Cardiovasc Qual Outcomes 2014; 7(6): 929-35.
[http://dx.doi.org/10.1161/CIRCOUTCOMES.114.001144] [PMID: 25249561]
[22]
Di Angelantonio E, Chowdhury R, Sarwar N, Aspelund T, Danesh J, Gudnason V. Chronic kidney disease and risk of major cardiovascular disease and non-vascular mortality: Prospective population based cohort study. BMJ 2010; 341(7776): c4986.
[http://dx.doi.org/10.1136/bmj.c4986] [PMID: 20884698]
[23]
Penko M, Hojs Fabjan T, Bevc S, Kanič V, Hojs R. A prospective study about impact of renal dysfunction and morbidity and mortality on cardiovascular events after ischemic stroke. Cardiol J 2014; 21(2): 163-9.
[http://dx.doi.org/10.5603/CJ.a2013.0083] [PMID: 23799556]
[24]
Wang IK, Lien LM, Lee JT, et al. Taiwan Stroke Registry Investigators. Renal dysfunction increases the risk of recurrent stroke in patients with acute ischemic stroke. Atherosclerosis 2018; 277: 15-20.
[http://dx.doi.org/10.1016/j.atherosclerosis.2018.07.033] [PMID: 30170219]
[25]
Sarfo FS, Mobula LM, Sarfo-Kantanka O, et al. Estimated glomerular filtration rate predicts incident stroke among Ghanaians with diabetes and hypertension. J Neurol Sci 2019; 396: 140-7.
[http://dx.doi.org/10.1016/j.jns.2018.11.017] [PMID: 30471633]
[26]
Zeng Q, Lin K, Yao M, Wei L. Significant correlation between cystatin C, cerebral infarction, and potential biomarker for increased risk of stroke. Curr Neurovasc Res 2015; 12(1): 40-6.
[http://dx.doi.org/10.2174/1567202612666150102150941] [PMID: 25557377]
[27]
Xiao D, Liu H, Zhang H, Luo Y. Impact of cystatin C levels on infarct size and hemorrhage volume in acute cerebral stroke. J Neurol 2012; 259(10): 2053-9.
[http://dx.doi.org/10.1007/s00415-012-6453-2] [PMID: 22349874]
[28]
Xu Z, Leng C, Yang B, et al. Serum cystatin C is associated with large cerebral artery stenosis in acute ischemic stroke. Oncotarget 2017; 8(40): 67181-8.
[http://dx.doi.org/10.18632/oncotarget.18061] [PMID: 28978025]
[29]
Zhang JB, Jü XH, Wang J, Sun HR, Li F. Serum cystatin C and cerebral microbleeds in patients with acute cerebral stroke. J Clin Neurosci 2014; 21(2): 268-73.
[http://dx.doi.org/10.1016/j.jocn.2013.04.014] [PMID: 24139136]
[30]
Hojs Fabjan T, Penko M, Hojs R. Newer glomerular filtration rate estimating equations for the full age spectrum based on serum creatinine and cystatin C in predicting mortality in patients with ischemic stroke. Eur J Intern Med 2018; 52: 67-72.
[http://dx.doi.org/10.1016/j.ejim.2018.02.005] [PMID: 29429860]
[31]
Shi J, Peng H, You S, et al. Increase in neutrophils after recombinant tissue plasminogen activator thrombolysis predicts poor functional outcome of ischaemic stroke: A longitudinal study. Eur J Neurol 2018; 25(4): 687-e45.
[http://dx.doi.org/10.1111/ene.13575] [PMID: 29341345]
[32]
Jauch EC, Saver JL, Adams HP Jr, et al. American Heart Association Stroke Council; Council on Cardiovascular Nursing; Council on Peripheral Vascular Disease; Council on Clinical Cardiology. Guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013; 44(3): 870-947.
[http://dx.doi.org/10.1161/STR.0b013e318284056a] [PMID: 23370205]
[33]
Shi J, Cao Y, You S, et al. Young stroke patients treated with intravenous thrombolysis have a more favorable outcome and mortality compared with older patients. Curr Neurovasc Res 2017; 14(2): 141-8.
[http://dx.doi.org/10.2174/1567202614666170328095431] [PMID: 28356003]
[34]
Bath PM, Lees KR, Schellinger PD, et al. European Stroke Organisation Outcomes Working Group. Statistical analysis of the primary outcome in acute stroke trials. Stroke 2012; 43(4): 1171-8.
[http://dx.doi.org/10.1161/STROKEAHA.111.641456] [PMID: 22426314]
[35]
Yang B, Zhu J, Miao Z, et al. Cystatin C is an independent risk factor and therapeutic target for acute ischemic stroke. Neurotox Res 2015; 28(1): 1-7.
[http://dx.doi.org/10.1007/s12640-015-9522-3] [PMID: 25697425]
[36]
Huang GX, Ji XM, Ding YC, Huang HY. Association between serum cystatin C levels and the severity or potential risk factors of acute ischemic stroke. Neurol Res 2016; 38(6): 518-23.
[http://dx.doi.org/10.1080/01616412.2016.1187825] [PMID: 27320246]
[37]
Umemura T, Kawamura T, Mashita S, Kameyama T, Sobue G. Higher Levels of Cystatin C are associated with extracranial carotid artery steno-occlusive disease in patients with noncardioembolic ischemic stroke. Cerebrovasc Dis Extra 2016; 6(1): 1-11.
[http://dx.doi.org/10.1159/000443338] [PMID: 26997949]
[38]
Baird AE, Dambrosia J, Janket S, et al. A three-item scale for the early prediction of stroke recovery. Lancet 2001; 357(9274): 2095-9.
[http://dx.doi.org/10.1016/S0140-6736(00)05183-7] [PMID: 11445104]
[39]
Thijs VN, Lansberg MG, Beaulieu C, Marks MP, Moseley ME, Albers GW. Is early ischemic lesion volume on diffusion-weighted imaging an independent predictor of stroke outcome? A multivariable analysis. Stroke 2000; 31(11): 2597-602.
[http://dx.doi.org/10.1161/01.STR.31.11.2597] [PMID: 11062281]
[40]
Hojs Fabjan T, Penko M, Hojs R. Cystatin C, creatinine, estimated glomerular filtration, and long-term mortality in stroke patients. Ren Fail 2014; 36(1): 81-6.
[http://dx.doi.org/10.3109/0886022X.2013.832314] [PMID: 24028541]
[41]
Dong X, Nao J. Cystatin C as an index of acute cerebral infraction recurrence: One-year follow-up study. Int J Neurosci 2019; 129(1): 36-41. [https://www.ncbi.nlm.nih.gov/pubmed/30033802
[42]
Hojs FT, Penko M, Hojs R. Cystatin C, creatinine, estimated glomerular filtration, and long-term mortality in stroke patients. Ren Fail 2014; 36(1): 81-6. [https://www.ncbi.nlm.nih.gov/pubmed/24028541
[43]
Fang Z, Deng J, Wu Z, et al. Cystatin C is a crucial endogenous protective determinant against stroke. Stroke 2017; 48(2): 436-44.
[44]
Amin F, Khan MS, Bano B. Mammalian cystatin and protagonists in brain diseases. J Biomol Struct Dyn 2019. [EPub ahead of Print [https://www.ncbi.nlm.nih.gov/pubmed/31107181
[45]
Zhang Y, Sun L. Cystatin C in Cerebrovascular Disorders. Curr Neurovasc Res 2017; 14(4): 406-14. [https://www.ncbi.nlm.nih.gov/pubmed/29149834
[46]
Balta S, Demirkol S, Ay SA, et al. Serum cystatin‐C levels correlate with endothelial dysfunction in patients with the metabolic syndrome. J Intern Med 2013; 274(2): 200-1. [https://www.ncbi.nlm.nih.gov/pubmed/23600475
[47]
Navab KD, Elboudwarej O, Gharif M, et al. Chronic inflammatory disorders and accelerated atherosclerosis: Chronic kidney disease. Curr Pharm Des 2011; 17(1): 17-20. [https://www.ncbi.nlm.nih.gov/pubmed/21222643
[48]
Song TJ, Kim J, Song D, et al. Association of cerebral microbleeds with mortality in stroke patients having atrial fibrillation. Neurology 2014; 83(15): 1308-15. [https://www.ncbi.nlm.nih.gov/pubmed/25186853
[49]
Yang S, Cai J, Lu R, et al. Association between serum cystatin c level and total magnetic resonance imaging burden of cerebral small vessel disease in patients with acute lacunar stroke. J Stroke Cerebrovasc Dis 2017; 26(1): 186-91. [https://www.ncbi.nlm.nih.gov/pubmed/27727072
[50]
Shuaib A, Butcher K, Mohammad AA, et al. Collateral blood vessels in acute ischaemic stroke: A potential therapeutic target. Lancet Neurol 2011; 10(10): 909-21. [https://www.ncbi.nlm.nih.gov/pubmed/21939900
[51]
Liu J, Sukhova GK, Sun JS, et al. Lysosomal cysteine proteases in atherosclerosis. Arterioscler Thromb Vasc Biol 2004; 24(8): 1359-66. [https://www.ncbi.nlm.nih.gov/pubmed/15178558

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