Blood biomarkers associated with neurological deterioration in patients with acute penetrating artery territory infarction: A multicenter prospective observational study.
Background and purpose Neurological deterioration in acute penetrating artery territory infarction is unpredictable and associated with unfavorable clinical outcomes. The aim of this prospective study was to clarify the cause of neurological worsening and predict clinical outcomes using blood biomarkers. Methods Eight Japanese stroke centers participated. Blood samples were obtained within 24 h (the first sampling) and on day 7 in hospital (the second sampling) in patients with penetrating artery territory infarction, arriving within two days of stroke onset. Symptomatic worsening was defined as a minimum increase of one point on the National Institutes of Health Stroke Scale. Poor outcome was defined as a modified Rankin Scale score of ≥3 at 90 days after ictus. Results Of the 89 patients, 25 (28%) had symptomatic worsening, and 25 (28%) had a poor outcome. Although tumor necrosis factor-alpha, high-sensitivity C-reactive protein levels were significantly increased in both groups at the second sampling, soluble lectin-like oxidized low-density lipoprotein receptor-1, CD40 ligand, and pro-adrenomedullin levels were significantly increased and ADAMTS13 activity was decreased in symptomatic worsening patients ( p < 0.05 for all). After multivariate adjustment, a low number of CD34+ cells at the first sampling was an independent predictor of poor outcome (odds ratio, 0.20; 95% confidence interval, 0.04-0.74, p = 0.011, per 1 cell/µl increase). Conclusions Blood biomarkers associated with atherosclerotic processes seem to be an indication for symptomatic worsening, and the number of CD34+ cells may help to predict three-month functional outcome in patients with penetrating artery territory infarction.
1 Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan.
Tomohiro
T
Kawano
1 Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan.
Kotaro
K
Miyashita
1 Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan.
Mariko
M
Takeuchi
2 Department of Neurology, Kyoto Second Red Cross Hospital, Kyoto, Japan.
Yoshinari
Y
Nagakane
2 Department of Neurology, Kyoto Second Red Cross Hospital, Kyoto, Japan.
Yasumasa
Y
Yamamoto
3 Department of Neurosurgery and Stroke Center, Nakamura Memorial Hospital, Sapporo, Japan.
Kenji
K
Kamiyama
4 Department of Neurology, National Hospital Organization, Okayama Medical Center, Okayama, Japan.
Yasuhiro
Y
Manabe
5 Department of Neurology, Kobe City Medical Center General Hospital, Kobe, Japan.
Kenichi
K
Todo
6 Department of Internal Medicine, Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan.
Norifumi
N
Metoki
7 Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan.
Yasuhisa
Y
Akaiwa
8 Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Kazunori
K
Toyoda
1 Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan.
Kazuyuki
K
Nagatsuka
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D018952:Antigens, CD34 / Q000378:metabolism; D015415:Biomarkers / Q000097:blood; D018450:Disease Progression; D066026:Endothelial Progenitor Cells / Q000502:physiology*; D005260:Female; D006801:Humans; D020243:Infarction, Anterior Cerebral Artery / Q000175:diagnosis*; D007564:Japan; D008297:Male; D008875:Middle Aged; D019636:Neurodegenerative Diseases / Q000175:diagnosis*; D011379:Prognosis; D016896:Treatment Outcome; D014950:Wounds, Penetrating / Q000175:diagnosis*
D018952:Antigens, CD34; D015415:Biomarkers
Acute penetrating artery territory infarction; atherosclerosis; blood biomarker; endothelial progenitor cell; neurological deterioration