Abstract
Objectives
Hemorrhagic transformation (HT) is a complication occurring in patients with acute
ischemic stroke (AIS) either spontaneously or post-thrombolysis leading to significant
morbidity and mortality. We assessed circulating matrix metalloproteinase-9 (MMP-9),
Claudin-5, and soluble serum stimulation-2 (sST2) in HT and stroke severity in AIS
based on their temporal distribution.
Materials and methods
We prospectively enrolled 111 AIS patients within 12 h from onset. Patient demographic,
clinical, and imaging details were documented. Follow-up imaging was conducted 24–48 h
after admission. Blood samples were taken at three time-points from stroke onset.
HT was classified according to the European Co-operative Acute Stroke Study-III(ECASS-III).
Stroke severity was assessed using the National Institutes of Health Stroke Scale
(NIHSS). Multiple logistic regression and receiver operating characteristic curve
were conducted to determine the discriminative capacity.
Results
Mean age was 62.3 ± 11.7 years and median baseline NIHSS was 12[IQR 8.0–18.0]. HT
was detected in 30(27%) patients. Biomarker levels at 12 h were elevated with median
MMP-9 concentration of 153.9 ng/mL[IQR 110.6–309 ng/mL] indicating a trend toward
significant positive correlation with HT(P = 0.05). Claudin-5 levels at 12 h was elevated but was not statistically significant
(43.1 pg/mL[IQR:26.7–72.6 pg/mL] vs 59.4 pg/mL[IQR:24.5–100.8 pg/mL];P = 0.4). Multiple logistic regression indicated Claudin-5 levels at 12 h (OR 9.46;95%
CI:1.97–64.6;P = 0.010) and baseline low ASPECTS score(OR 20.3;95% CI:3.46–193; P = 0.003) independently predicted HT. MMP-9 at 12 h was significantly elevated in
patients with moderate to severe strokes (P = 0.04).
Conclusions
Claudin-5 and low ASPECTS independently predicted HT. MMP-9 was positively correlated
with baseline stroke severity.
Keywords
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Article info
Publication history
Published online: November 14, 2022
Accepted:
November 5,
2022
Received in revised form:
October 20,
2022
Received:
August 26,
2022
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106875
Copyright
© 2022 Elsevier Inc. All rights reserved.
