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Current Neurovascular Research

Editor-in-Chief

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

Research Article

Value of IMA, IMAR, the IMA Index, and Other Hematological Features in Predicting AIS Caused by MCA Stenosis/Occlusion

Author(s): Sijin Li, Xing Chen, Huan Yang, Huiyang Li and Biqiong Ren*

Volume 19, Issue 2, 2022

Published on: 22 July, 2022

Page: [137 - 149] Pages: 13

DOI: 10.2174/1567202619666220516145120

Price: $65

Abstract

Objective: In this study, we investigated the relationship between serum ischemic modified albumin (IMA) levels and other hematologic features and middle cerebral artery (MCA) severe stenosis/occlusion in acute ischemic stroke (AIS) patients.

Methods: The levels of serum IMA and Albumin (ALB) of 169 AIS patients were measured, and the ratio of IMA to albumin (IMAR) and the albumin-adjusted ischemia-modified albumin index (IMA index) were calculated. Different combinations of other hematologic changes and clinical features of the patients were analyzed.

Results: The results indicated that the levels of blood IMA and IMAR were significantly higher in the group with severe intracranial stenosis/occlusion than in the group with non-severe stenosis/ occlusion in AIS patients, while the CHE levels were significantly lower than those in the other groups. In the MCA severe stenosis/occlusion group, the levels of blood IMA and IMAR were significantly higher than that in the other vascular severe stenosis/occlusion groups, while the IMA index, ALB, and CHE were significantly lower than that in the other groups. Multiple linear regression analysis showed a significant negative correlation between IMA and albumin. A combined diagnostic ROC curve analysis showed that among AIS patients, the best combination for determining severe stenosis/occlusion of the great intracranial arteries was the admission NIHSS score + CHE (AUC = 0.783). The best combination for determining severe stenosis or occlusion of the MCA in AIS patients was IMAR combined with the admission NIHSS score and CHE (AUC = 0.827).

Conclusion: The combined use of IMA, IMAR, and the IMA index has some diagnostic value in AIS caused by severe stenosis or occlusion of the MCA. IMAR, CHE, and the admission NIHSS scores are the best combinations to determine whether an AIS patient has severe stenosis or occlusion of the MCA.

Keywords: Acute ischemic stroke, ischemia-modified albumin, ratio of IMA to albumin, albumin-adjusted ischemia modified albumin index, middle cerebral artery stenosis, severe stenosis, occlusion.

[1]
Zhou M, Wang H, Zeng X, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet 2019; 394(10204): 1145-58.
[http://dx.doi.org/10.1016/S0140-6736(19)30427-1] [PMID: 31248666]
[2]
Wong KS, Huang YN, Gao S, Lam WWM, Chan YL, Kay R. Intracranial stenosis in Chinese patients with acute stroke. Neurology 1998; 50(3): 812-3.
[http://dx.doi.org/10.1212/WNL.50.3.812] [PMID: 9521286]
[3]
Banerjee C, Chimowitz MI. Stroke caused by atherosclerosis of the major intracranial arteries. Circ Res 2017; 120(3): 502-13.
[http://dx.doi.org/10.1161/CIRCRESAHA.116.308441] [PMID: 28154100]
[4]
Wang Y, Zhao X, Liu L, et al. Prevalence and outcomes of symptomatic intracranial large artery stenoses and occlusions in China: The Chinese Intracranial Atherosclerosis (CICAS) Study. Stroke 2014; 45(3): 663-9.
[http://dx.doi.org/10.1161/STROKEAHA.113.003508] [PMID: 24481975]
[5]
Wang L, Chen L, Rui D. Central Nervous System Disease Location Diagnosis Diagram. Beijing: People’s Medical Publishing House 2014.
[6]
Chinese Medical Association Neurology Branch, Cerebrovascular Disease Group, Neurology Branch of Chinese Medical Association. Guidelines for the diagnosis and treatment of acute ischemic stroke in China. Chin J Neurol 2018; 9(51): 666-82.
[7]
Chinese Medical Association Neurology Branch, Cerebrovascular Disease Group, Neurology Branch of Chinese Medical Association. Main points of diagnosis of major cerebrovascular diseases in China (2019 Edition). Chin J Neurol 2019; 9(52): 710-5.
[8]
Shi W, Tang G, Zhou X, Ye Y. Appraising the accuracy of ischaemia-modified albumin in diagnosing stroke: A systematic review and meta-analysis. Cerebrovasc Dis 2021; 50(4): 365-70.
[http://dx.doi.org/10.1159/000514382] [PMID: 33789271]
[9]
Ma J, Shen L, Bao L, et al. A novel prognosis prediction model, including cytotoxic T lymphocyte‐associated antigen‐4, ischemia‐modified albumin, lipoprotein‐associated phospholipase A2, glial fibrillary acidic protein, and homocysteine, for ischemic stroke in the Chinese hypertensive population. J Clin Lab Anal 2021; 35(5): e23756.
[http://dx.doi.org/10.1002/jcla.23756] [PMID: 33734490]
[10]
Babu MS, Kaul S, Dadheech S, Rajeshwar K, Jyothy A, Munshi A. Serum albumin levels in ischemic stroke and its subtypes: Correlation with clinical outcome. Nutrition 2013; 29(6): 872-5.
[http://dx.doi.org/10.1016/j.nut.2012.12.015] [PMID: 23422540]
[11]
Lang Q, Zhou M, Feng H, Guo J, Chen N, He L. Research on the relationship between fibrinogen level and subtypes of the TOAST criteria in the acute ischemic stroke. BMC Neurol 2013; 13(1): 207.
[http://dx.doi.org/10.1186/1471-2377-13-207] [PMID: 24354692]
[12]
Lee YW, Kim HJ, Cho YH, Shin HB, Choi TY, Lee YK. Application of albumin-adjusted ischemia modified albumin index as an early screening marker for acute coronary syndrome. Clin Chim Acta 2007; 384(1-2): 24-7.
[http://dx.doi.org/10.1016/j.cca.2007.05.003] [PMID: 17570353]
[13]
Liu Z, Chen X. Simple bioconjugate chemistry serves great clinical advances: Albumin as a versatile platform for diagnosis and precision therapy. Chem Soc Rev 2016; 45(5): 1432-56.
[http://dx.doi.org/10.1039/C5CS00158G] [PMID: 26771036]
[14]
Borisenko VG, Kasymova GA, Borisenko SN. Properties of human serum albumin in ischemic heart disease. Ukr Biokhim Zh [1978] 1984; 56(2): 185-7.
[15]
Bar-Or D, Lau E, Rao N, Bampos N, Winkler JV, Curtis CG. Reduction in the cobalt binding capacity of human albumin with myocardial ischemia. Ann Emerg Med 1999; 34(4): S56.
[http://dx.doi.org/10.1016/S0196-0644(99)80299-6]
[16]
Bar-Or D, Lau E, Winkler JV. A novel assay for cobalt-albumin binding and its potential as a marker for myocardial ischemia-a preliminary report. J Emerg Med 2000; 19(4): 311-5.
[http://dx.doi.org/10.1016/S0736-4679(00)00255-9] [PMID: 11074321]
[17]
Shevtsova A, Gordiienko I, Tkachenko V, Ushakova G. ischemia-modified albumin: Origins and clinical implications. Dis Markers 2021; 2021: 1-18.
[http://dx.doi.org/10.1155/2021/9945424] [PMID: 34336009]
[18]
Sbarouni E, Georgiadou P, Voudris V. Ischemia modified albumin changes – review and clinical implications. Clin Chem Lab Med 2011; 49(2): 177-84.
[http://dx.doi.org/10.1515/CCLM.2011.037] [PMID: 21083441]
[19]
Sinha MK, Gaze DC, Tippins JR, Collinson PO, Kaski JC. Ischemia modified albumin is a sensitive marker of myocardial ischemia after percutaneous coronary intervention. Circulation 2003; 107(19): 2403-5.
[http://dx.doi.org/10.1161/01.CIR.0000072764.18315.6B] [PMID: 12742986]
[20]
Schachter M. The pathogenesis of atherosclerosis. Int J Cardiol 1997; 62 (Suppl. 2): S3-7.
[http://dx.doi.org/10.1016/S0167-5273(97)00235-0] [PMID: 9488189]
[21]
Bar-Or D, Curtis G, Rao N, Bampos N, Lau E. Characterization of the Co2+ and Ni2+ binding amino-acid residues of the N-terminus of human albumin. Eur J Biochem 2001; 268(1): 42-8.
[http://dx.doi.org/10.1046/j.1432-1327.2001.01846.x] [PMID: 11121100]
[22]
Nayak AR, Kashyap RS, Kabra D, Purohit HJ, Taori GM, Daginawala HF. Prognostic significance of ischemia-modified albumin in acute ischemic stroke patients: A preliminary study. Ann Neurosci 2011; 18(1): 5-7.
[http://dx.doi.org/10.5214/ans.0972.7531.1118103] [PMID: 25205910]
[23]
Can S, Akdur O, Yildirim A, Adam G, Cakir DU, Karaman HIO. Myelin basic protein and ischemia modified albumin levels in acute ischemic stroke cases. Pak J Med Sci 2015; 31(5): 1110-4.
[http://dx.doi.org/10.12669/pjms.315.7702] [PMID: 26648996]
[24]
Zhao X, Zhao M, Pang B, Zhu Y, Liu J. Diagnostic value of combined serological markers in the detection of acute cerebral infarction. Medicine (Baltimore) 2021; 100(36): e27146.
[http://dx.doi.org/10.1097/MD.0000000000027146] [PMID: 34516506]
[25]
Valle Gottlieb MG, da Cruz IBM, Duarte MMF, et al. Associations among metabolic syndrome, ischemia, inflammatory, oxidatives, and lipids biomarkers. J Clin Endocrinol Metab 2010; 95(2): 586-91.
[http://dx.doi.org/10.1210/jc.2009-1592] [PMID: 20016051]
[26]
Kurz K, Voelker R, Zdunek D, et al. Effect of stress-induced reversible ischemia on serum concentrations of ischemia-modified albumin, natriuretic peptides and placental growth factor. Clin Res Cardiol 2007; 96(3): 152-9.
[http://dx.doi.org/10.1007/s00392-007-0469-5] [PMID: 17180576]
[27]
Nativel M, Schneider F, Saulnier PJ, et al. Prognostic values of inflammatory and redox status biomarkers on the risk of major lower-extremity artery disease in individuals with type 2 diabetes. Diabetes Care 2018; 41(10): 2162-9.
[http://dx.doi.org/10.2337/dc18-0695] [PMID: 30072406]
[28]
Uzel M, Oray NC, Bayram B, et al. Novel biochemical marker for differential diagnosis of seizure: Ischemia-modified albumin. Am J Emerg Med 2014; 32(9): 962-5.
[http://dx.doi.org/10.1016/j.ajem.2014.05.003] [PMID: 24997108]
[29]
Du X, Ma J, Li X, Yang H. Serum albumin and ischemic stroke. Int. J Cerebrovas Dis 2015; 7(23): 532-6.
[30]
Atik İ, Kozacı N, Beydilli İ, Avcı M, Ellidağ H, Keşaplı M. Investigation of oxidant and antioxidant levels in patients with acute stroke in the emergency service. Am J Emerg Med 2016; 34(12): 2379-83.
[http://dx.doi.org/10.1016/j.ajem.2016.08.062] [PMID: 27624369]
[31]
Assayag EB, Shenhar-Tsarfaty S, Ofek K, et al. Serum cholinesterase activities distinguish between stroke patients and controls and predict 12-month mortality. Mol Med 2010; 16(7-8): 278-86.
[http://dx.doi.org/10.2119/molmed.2010.00015] [PMID: 20464061]
[32]
Li M, Chen Y, Zhang Y, et al. Admission serum cholinesterase concentration for prediction of in-hospital mortality in very elderly patients with acute ischemic stroke: A retrospective study. Aging Clin Exp Res 2020; 32(12): 2667-75.
[http://dx.doi.org/10.1007/s40520-020-01498-z] [PMID: 32067216]
[33]
Tsuyama J, Nakamura A, Ooboshi H, Yoshimura A, Shichita T. Pivotal role of innate myeloid cells in cerebral post-ischemic sterile inflammation. Semin Immunopathol 2018; 40(6): 523-38.
[http://dx.doi.org/10.1007/s00281-018-0707-8] [PMID: 30206661]
[34]
Coveney S, Murphy S, Belton O, et al. Inflammatory cytokines, high-sensitivity C-reactive protein, and risk of one-year vascular events, death, and poor functional outcome after stroke and transient ischemic attack. Int J Stroke 2022; 17(2): 163-71.
[http://dx.doi.org/10.1177/1747493021995595] [PMID: 33538655]
[35]
Whiteley W, Jackson C, Lewis S, et al. Inflammatory markers and poor outcome after stroke: A prospective cohort study and systematic review of interleukin-6. PLoS Med 2009; 6(9): e1000145.
[http://dx.doi.org/10.1371/journal.pmed.1000145] [PMID: 19901973]
[36]
Adiguzel A, Arsava EM, Topcuoglu MA. Temporal course of peripheral inflammation markers and indexes following acute ischemic stroke: Prediction of mortality, functional outcome, and stroke-associated pneumonia. Neurol Res 2022; 44(3): 224-31.
[PMID: 34514954]
[37]
Makris K, Haliassos A, Chondrogianni M, Tsivgoulis G. Blood biomarkers in ischemic stroke: Potential role and challenges in clinical practice and research. Crit Rev Clin Lab Sci 2018; 55(5): 294-328.
[http://dx.doi.org/10.1080/10408363.2018.1461190] [PMID: 29668333]
[38]
Balling M, Nordestgaard BG, Langsted A, Varbo A, Kamstrup PR, Afzal S. Small dense low-density lipoprotein cholesterol predicts atherosclerotic cardiovascular disease in the copenhagen general population study. J Am Coll Cardiol 2020; 75(22): 2873-5.
[http://dx.doi.org/10.1016/j.jacc.2020.03.072] [PMID: 32498816]
[39]
QiaoZhen X. AiGuo M, Tong W, JingJing L, HaiYing L. Correlation between of small dense low‐density lipoprotein cholesterol with acute cerebral infarction and carotid atherosclerotic plaque stability. J Clin Lab Anal 2019; 33(6): e22891.
[http://dx.doi.org/10.1002/jcla.22891] [PMID: 30955225]
[40]
Li J, Pan Y, Xu J, et al. Residual inflammatory risk predicts poor prognosis in acute ischemic stroke or transient ischemic attack patients. Stroke 2021; 52(9): 2827-36.
[http://dx.doi.org/10.1161/STROKEAHA.120.033152] [PMID: 34281380]
[41]
Shi Y, Evans JE, Rock KL. Molecular identification of a danger signal that alerts the immune system to dying cells. Nature 2003; 425(6957): 516-21.
[http://dx.doi.org/10.1038/nature01991] [PMID: 14520412]
[42]
Zhou H, Huang C, Liu R, Liu C, Ma C, Ren X. Lack of association between serum homocysteine level and middle cerebral artery stenosis. Brain Behav 2019; 9(8): e01297.
[http://dx.doi.org/10.1002/brb3.1297] [PMID: 31225691]
[43]
Chamorro Á, Lo EH, Renú A, van Leyen K, Lyden PD. The future of neuroprotection in stroke. J Neurol Neurosurg Psychiatry 2021; 92(2): 129-35.
[http://dx.doi.org/10.1136/jnnp-2020-324283] [PMID: 33148815]

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