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Observational Study
. 2021 Apr;28(4):1265-1274.
doi: 10.1111/ene.14663. Epub 2020 Dec 26.

Cystatin C is a potential predictor of unfavorable outcomes for cerebral ischemia with intravenous tissue plasminogen activator treatment: A multicenter prospective nested case-control study

Zihan Chang  1 , Haiqiang Zou  2 , Zhenchao Xie  1 , Bin Deng  1 , Rongfang Que  1 , Zifeng Huang  1 , Guomei Weng  3 , Zhihuan Wu  3 , Ying Pan  4 , Yanping Wang  4 , Mengyan Li  5 , Huifang Xie  1 , Shuzhen Zhu  1 , Li Xiong  6 , Vincent Ct Mok  6 , Kunlin Jin  7 , Midori A Yenari  8 , Xiaobo Wei  1 , Qing Wang  1
Affiliations
Observational Study

Cystatin C is a potential predictor of unfavorable outcomes for cerebral ischemia with intravenous tissue plasminogen activator treatment: A multicenter prospective nested case-control study

Zihan Chang et al. Eur J Neurol. 2021 Apr.

Abstract

Background and purpose: The aim of this study was to explore whether cystatin C (CysC) could be used as a potential predictor of clinical outcomes in acute ischemic stroke (AIS) patients treated with intravenous tissue plasminogen activator (IV-tPA).

Methods: We performed an observational study including a retrospective analysis of data from 125 AIS patients with intravenous thrombolysis. General linear models were applied to compare CysC levels between groups with different outcomes; logistic regression analysis and receiver-operating characteristic curves were adopted to identify the association between CysC and the therapeutic effects.

Results: Compared with the "good and sustained benefit" (GSB) outcome group (defined as ≥4-point reduction in National Institutes of Health Stroke Scale or a score of 0-1 at 24 h and 7 days) and the "good functional outcome" (GFO) group (modified Rankin Scale score 0-2 at 90 days), serum CysC baseline levels were increased in the non-GSB and non-GFO groups. Logistic regression analysis found that CysC was an independent negative prognostic factor for GSB (odds ratio [OR] 0.010; p = 0.005) and GFO (OR 0.011; p = 0.021) after adjustment for potential influencing factors. Receiver-operating characteristic curves showed the CysC-involved combined models provided credible efficacy for predicting post-90-day favorable clinical outcome (area under the curve 0.86; p < 0.001).

Conclusions: Elevated serum CysC is independently associated with unfavorable clinical outcomes after IV-tPA therapy in AIS. Our findings provide new insights into discovering potential mediators for neuropathological process or treatment in stroke.

Keywords: acute ischemic stroke; clinical outcome; cystatin C; intravenous tissue plasminogen activator.

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Comment in

  • Cystatin C and intravenous thrombolysis.
    Peng M, Chen Y, Geng G. Peng M, et al. Eur J Neurol. 2021 Apr;28(4):e28. doi: 10.1111/ene.14722. Epub 2021 Jan 22. Eur J Neurol. 2021. PMID: 33421235 No abstract available.

References

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