title: Blood biomarkers role in acute ischemic stroke patients: higher is worse or better?
abstract: BACKGROUND
  Thrombolytic therapy (TT) for acute ischemic stroke (AIS) can provoke bleeding's complication depending on the ischemic lesion (IL) dimension. Inflammation involved in the setting of acute ischaemic stroke, is associated with infarct size. We aimed to study the independent correlation and association between clinical panel of routinely identified biomarkers, including inflammatory parameters, and cerebral IL dimension and site.
  
  
  RESULTS
  We evaluated eleven biomarkers in 105 unrelated patients during their hospitalization after acute stroke event. Our data indicate a significant association of: a) confluent IL size with 4th quartile of Erythrocyte Sedimentation Rate (ESR) (OR = 5.250; 95% CI, 1.002 to 27.514) and an independent correlation with sex; b) confluent IL size with 3rd quartile of fibrinogen (OR = 5.5; 95% CI, 1.027 to 29.451); c) confluent IL size with 3rd quartile of platelets (OR= 0.059; 95% CI, 0.003 to 1.175) and independent correlation with sex; d) smaller IL size (OR = 5.25; 95% CI, 1.351 to 20.396) with 3rd quartile of albumin levels and nodular and parenchimal IL size with 2nd (OR = 0.227; 95% CI, 0.053 to 0.981), 3rd (OR = 0.164; 95% CI, 0.038 to 0.711) and 4th (OR = 0.205; 95% CI, 0.048 to 0.870) quartiles albumin levels; e) smaller IL size with 3rd quartile triglycerides (TG) levels (OR = 9; 95% CI, 2.487 to 32.567) and an independent correlation with anterior location. Smaller IL size, anterior AIS turned out to be independently correlated with high serum albumin levels. Finally, high INR and PTT values were associated with worse NIHSS clinical outcomes in contrast to that observed with higher albumin level.
  
  
  CONCLUSIONS
  We provide evidence of routine biomarkers levels correlation with acute IL size, independently of age and sex. In addition, we highlight the importance of differentiation of biomarkers normal interval levels for further improvement not only of the clinical decision making but also in post-acute clinical outcome management.
authors.affiliation: Clinical Epidemiology & Biostatistics Unit, IRCCS INM Neuromed, Pozzilli (IS), Italy.
authors.forename: Aliaksei
authors.initials: A
authors.lastname: Kisialiou
authors.affiliation: Stroke Unit, IRCCS INM Neuromed, Pozzilli (IS), Italy.
authors.forename: Giordana
authors.initials: G
authors.lastname: Pelone
authors.affiliation: Vascular Physiopathology Unit, IRCCS INM Neuromed, Pozzilli (IS), Italy.
authors.forename: Albino
authors.initials: A
authors.lastname: Carrizzo
authors.affiliation: Diagnostical & Therapeutical NeuroRadiology Unit, IRCCS INM Neuromed, Pozzilli (IS), Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Grillea
authors.affiliation: Department of Neuroscience, University of Naples Federico II, Naples (NA), Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Trimarco
authors.affiliation: Department of Clinical Medicine, Cardiovascular and Immunological Sciences, University of Naples Federico II, Naples (NA), Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Marino
authors.affiliation: NeuroRehabilitation Unit, IRCCS INM Neuromed, Pozzilli (IS), Italy.
authors.forename: Michelangelo
authors.initials: M
authors.lastname: Bartolo
authors.affiliation: NeuroRehabilitation Unit, IRCCS INM Neuromed, Pozzilli (IS), Italy.
authors.forename: Alessandro Marco
authors.initials: AM
authors.lastname: De Nunzio
authors.affiliation: Stroke Unit, IRCCS INM Neuromed, Pozzilli (IS), Italy.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Grella
authors.affiliation: AngioCardioNeurology Unit, IRCCS INM Neuromed, Pozzilli (IS), Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Landolfi
authors.affiliation: Cardiovascular Research Unit, IRCCS Multimedica, Milano, Italy.|Department of Medicine and Surgery, University of Salerno, Salerno, Italy.
authors.forename: Annibale
authors.initials: A
authors.lastname: Puca
authors.affiliation: Diagnostical & Therapeutical NeuroRadiology Unit, IRCCS INM Neuromed, Pozzilli (IS), Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Colonnese
authors.affiliation: Vascular Physiopathology Unit, IRCCS INM Neuromed, Pozzilli (IS), Italy.|Department of Medicine and Surgery, University of Salerno, Salerno, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: Vecchione