title: Inflammatory and metabolic markers and short-time outcome in patients with acute ischemic stroke in relation to TOAST subtypes.
abstract: The aim of this study was to evaluate the association between inflammatory and metabolic markers and short-time outcome with acute ischemic stroke subtypes. A total of 121 patients was classified according to TOAST criteria, such as large artery atherosclerosis (LAAS), lacunar infarct (LAC), cardioembolic infarct (CEI), other determined etiology (ODE), and undetermined etiology (UDE). The functional impairment was evaluated within the first eight hours of stroke and the outcome after three-month follow-up using the modified Rankin Scale. Blood samples were obtained up to 24 h of stroke. Compared with 96 controls, patients with LAAS, CEI, and LAC subtypes showed higher levels of white blood cells, high-sensitivity C-reactive protein (hsCRP), interleukin 6 (IL-6), metalloproteinase 9 (MMP-9), glucose, and iron (p < 0.05); and lower high-density lipoprotein cholesterol (HDL-C) (p < 0.0001); platelets, insulin, insulin resistance, and homocysteine were higher in LAC (p < 0.0001); ferritin was higher in LAAS (p < 0.0001); and total cholesterol (TC) was lower in LAAS and CEI (p < 0.01). When stroke subtypes were compared, insulin was higher in LAAS vs. LAC and in LAC vs. CEI (p < 0.05); and TC was lower in LAAS vs. LAC (p < 0.05). Outcome and rate of mortality after three-month were higher in LAAS vs. LAC (p < 0.001 and p = 0.0391 respectively). The results underscored the important role of the inflammatory response and metabolic changes in the pathogenesis of ischemic stroke subtypes that might be considered on the initial evaluation of stroke patients to identify those that could benefit with individualized therapeutic strategies that taken into account these markers after acute ischemic event.
authors.affiliation: Health Sciences Postgraduate Program, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil.|Department of Clinical Surgery, Health Sciences Center, and Neurosurgery Service of the University Hospital, State University of Londrina, Londrina, Paraná, Brazil.
authors.forename: Marcio Francisco
authors.initials: MF
authors.lastname: Lehmann
authors.affiliation: Health Sciences Postgraduate Program, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil.
authors.forename: Ana Paula
authors.initials: AP
authors.lastname: Kallaur
authors.affiliation: Health Sciences Postgraduate Program, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil.
authors.forename: Sayonara Rangel
authors.initials: SR
authors.lastname: Oliveira
authors.affiliation: Health Sciences Postgraduate Program, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil.
authors.forename: Daniela Frizon
authors.initials: DF
authors.lastname: Alfieri
authors.affiliation: Health Sciences Postgraduate Program, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil.
authors.forename: Franciele
authors.initials: F
authors.lastname: Delongui
authors.affiliation: Health Sciences Postgraduate Program, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil.
authors.forename: Johnathan
authors.initials: J
authors.lastname: de Sousa Parreira
authors.affiliation: Medicine Faculty, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil.
authors.forename: Maria Caroline Martins
authors.initials: MC
authors.lastname: de Araújo
authors.affiliation: Medicine Faculty, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil.
authors.forename: Carolina
authors.initials: C
authors.lastname: Rossato
authors.affiliation: Medicine Faculty, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil.
authors.forename: Jéssica Tavares
authors.initials: JT
authors.lastname: de Almeida
authors.affiliation: Medicine Faculty, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil.
authors.forename: Larissa Moliterno
authors.initials: LM
authors.lastname: Pelegrino
authors.affiliation: Medicine Faculty, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil.
authors.forename: Erick Frank
authors.initials: EF
authors.lastname: Bragato
authors.affiliation: Neurosciences Institute of Londrina, Londrina, Paraná, Brazil.
authors.forename: Ana Lucia Cruz Fürstenberger
authors.initials: AL
authors.lastname: Lehmann
authors.affiliation: Department of Pathology, Clinical Analysis, and Toxicology, Health Sciences Center, State University of Londrina, Av. Robert Koch, 60, CEP 86.038-440, Londrina, Paraná, Brazil.
authors.forename: Helena Kaminami
authors.initials: HK
authors.lastname: Morimoto
authors.affiliation: Department of Pathology, Clinical Analysis, and Toxicology, Health Sciences Center, State University of Londrina, Av. Robert Koch, 60, CEP 86.038-440, Londrina, Paraná, Brazil.
authors.forename: Marcell Alysson Batisti
authors.initials: MA
authors.lastname: Lozovoy
authors.affiliation: Department of Pathology, Clinical Analysis, and Toxicology, Health Sciences Center, State University of Londrina, Av. Robert Koch, 60, CEP 86.038-440, Londrina, Paraná, Brazil.
authors.forename: Andrea Name Colado
authors.initials: AN
authors.lastname: Simão
authors.affiliation: Department of Clinical Medicine, Health Sciences Center and Neurology Outpatient of the Outpatient Clinical Hospital, State University of Londrina, Londrina, Paraná, Brazil.
authors.forename: Damácio Ramon
authors.initials: DR
authors.lastname: Kaimen-Maciel
authors.affiliation: Department of Pathology, Clinical Analysis, and Toxicology, Health Sciences Center, State University of Londrina, Av. Robert Koch, 60, CEP 86.038-440, Londrina, Paraná, Brazil. reiche@sercomtel.com.br.
authors.forename: Edna Maria Vissoci
authors.initials: EM
authors.lastname: Reiche
mesh_terms: D000328:Adult; D000368:Aged; D000886:Anthropometry; D015415:Biomarkers; D002545:Brain Ischemia / Q000145:classification / Q000378:metabolism* / Q000473:pathology*; D001938:Brazil; D002097:C-Reactive Protein / Q000032:analysis; D016022:Case-Control Studies; D002544:Cerebral Infarction / Q000473:pathology; D005260:Female; D006801:Humans; D007249:Inflammation / Q000378:metabolism* / Q000473:pathology*; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D020780:Matrix Metalloproteinase 9 / Q000097:blood; D008875:Middle Aged; D012959:Socioeconomic Factors; D020521:Stroke / Q000145:classification / Q000378:metabolism* / Q000473:pathology*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; C508600:IL6 protein, human; D015850:Interleukin-6; D002097:C-Reactive Protein; D020780:Matrix Metalloproteinase 9
keywords: C-reactive protein; IL-6; Inflammation; Ischemic stroke; MMP-9; TOAST