Prognostic Biomarkers in Patients with Ischemic Stroke Who Received Thrombolytic Therapy

Background: The aim of the research was to evaluate the association between CRP (C-reactive protein), troponin I, d-dimer, creatinine, glucose, GFR (glomerular filtration rate) and LDL-C (low-density lipoprotein cholesterol) levels at the admission and the results of thrombolytic therapy. Materials and methods: 113 patients who underwent thrombolytic therapy for acute ischemic stroke in Pauls Stradins Clinical University Hospital from 01.01.2015 to 01.01.2016 were studied retrospectively. Blood samples were collected in the emergency department. The neurological status was estimated using the NIHSS (National Institute of Health Stroke Scale). The efficacy of thrombolytic therapy was assessed by comparing NIHSS score at the admission and after treatment. Afterward all patients were divided into three groups—the major improvement (NIHSS > 4), minor improvement (NIHSS ≤ 4) and without any clinical effect. Results: Only the median levels of GFR were significantly (p = 0.015) lower in patients who did not have any clinical improvements after thrombolytic therapy as compared to patients with the major or minor improvements (60.0, IQR (interquartile range) 42.4-72.3 mL/min/1.73m2; 83.2, IQR 65.3-98.3 mL/min/1.73m2 and 75.9, IQR 59.2-94.6 mL/min/1.73m2). Based on the ROC (receiver operating characteristic) curve, the optimal cut-off value of GFR level as an indicator for prediction of worsen clinical outcome after thrombolytic therapy was projected to be 61.65 mL/min/1.73m2, which yielded a sensitivity of 71.4% and a specificity of 24.5%, the area under the curve was 0.788 (95% CI (confidence interval), 0.648-0.928). According Spearman rank correlation test was founded statistically significant indirect correlation between GFR level and NIHSS score after treatment (r = -0.410, p = 0.020) in patients with severe stroke (NIHSS > 14). Conclusions: GFR level lower than 61.65 mL/min/1.73m2 at the admission could predict as a worse outcome, especially in patients with severe stroke.