Prognostic significance of serum cystatin C in acute brainstem infarctions patients - 29/03/24

Doi : 10.1016/j.neurol.2024.01.007

H. Li ^a,^{^{1
Haiyan Li, Bingjun Zhang, and Zhenchao Huang have contributed equally to this work.},}⁎ , B. Zhang ^a,^{^{1
Haiyan Li, Bingjun Zhang, and Zhenchao Huang have contributed equally to this work.}}, Z. Huang ^b,^{^{1
Haiyan Li, Bingjun Zhang, and Zhenchao Huang have contributed equally to this work.}}, H. Wu ^a, B. Qin ^a, L. Zhou ^c, Z. Lu ^a,^⁎ , F. Qin ^b,^⁎
^a Department of Neurology, center for Mental and neurological disorders and Diseases, The Third Affiliated Hospital of Sun Yat-Sen University, No 600 Tianhe Road, Guangzhou, Guangdong, China
^b Department of Neurosurgery, Center for Mental and Neurological Disorders and Diseases, Lingnan Hospital, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
^c Department of Rehabilitation Medicine, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China

^⁎Corresponding author.^⁎⁎Co-Corresponding author.^⁎⁎⁎Co-Corresponding author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Friday 29 March 2024

Highlights

•	The association between serum CysC and outcome in ischemic stroke patients remains contradictory.
•	We sought to assess the association between a specific stroke subgroup, brainstem infarction (BSI) and serum CysC.
•	Lower eGFR_CysC level was strongly correlated with functional outcome of BSI and HbA1c.
•	Lower eGFR_CysC may be a more helpful serologic biomarker for the prediction of prognosis in BSIs.

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Abstract

Objectives

Some studies show that high circulating cystatin C (CysC) may predict cardiovascular events and death after ischemic stroke onset. However, the association between serum CysC and outcome in ischemic stroke patients remains contradictory. We sought to assess the association between a specific stroke subgroup, brainstem infarction (BSI) and serum CysC.

Materials and methods

A total of 324 acute BSI patients were included in the study. Serum CysC was used to calculate estimated glomerular filtration rate (eGFR_CysC) at baseline. Modified Rankin scale score ((mRS) ≥3) six months after acute BSI indicates poor functional outcome. Patients were categorized into two groups according to mRS and eGFR_CysC. Logistic regression analyses were performed to determine independent risk factors.

Results

Lower eGFR_CysC was associated with hemoglobin A1c (HbA1c). This risk remained statistically significant after controlling for age, hypertension, initial National Institutes of Health Stroke Scale (NIHSS) score, HbA1c, fibrinogen and homocysteine. The serum eGFR_CysC levels were significantly lower in the poor functional outcome group than the good functional outcome group (P<0.001). Multivariate logistic regression analyses showed that eGFR_CysC level was significantly lower in the poor outcome group after adjusting for age, previous infarctions, initial NIHSS score, and HbA1c.

Conclusions

Lower eGFR_CysC levels were strongly associated with poor functional outcome of acute BSI patients with a higher HbA1c level. Lower eGFR_CysC may be a more helpful serologic biomarker for the prediction of prognosis in BSI.

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Keywords : Cystatin C, Hemoglobin A1c, Brainstem infarctions, Functional outcome