Title:Prognostic Value of Cystatin C in Acute Ischemic Stroke Patients with Intravenous Thrombolysis
Volume: 16
Issue: 4
Author(s): Jijun Shi, Chunyuan Zhang, Yongjun Cao*, Xinyuan Qu, Huihui Liu and Shoujiang You
Affiliation:
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou,China
Keywords:
Cystatin C, acute ischemic stroke, intravenous thrombolysis, prognosis, cystatin, inflammation.
Abstract:
Background: Less is known about the prognostic value of serum cystatin C in acute
ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT). The aim of the present
study was to examine the association between serum cystatin C levels and prognosis of AIS patients
after IVT.
Methods: Serum cystatin C was measured within 24 hours after recombinant tissue plasminogen
activator (rt-PA) treatment in 280 consecutively recruited patients with AIS. The main outcomes
included combination of death and major disability, death, major disability (modified Rankin Scale
score 3-5) and vascular events at 3-month follow-up.
Results: During the 3-month follow-up, 94 patients (33.6%) experienced death or major disability
(28 deaths and 66 major disability) and 49 patients (17.5%) experienced vascular events. After
multivariate adjustment, serum cystatin C was significantly associated with an increased risk of the
combined outcome of death and major disability (OR=4.51, P = 0.006). Adding serum cystatin C
quartiles to a model containing conventional risk factors improved the predictive power for the
combined outcome of death and major disability (continuous net reclassification index 43.88%, P
< 0.001; categorical net reclassification index 9.15%, P = 0.013; integrated discrimination improvement
2.31%, P = 0.025). Similar phenomena were also observed in major disability and vascular
events.
Conclusion: Higher levels of serum cystatin C in AIS patients after IVT were independently associated
with increased risks of poor functional outcomes and vascular events, especially combining
conventional risk factors, suggesting that serum cystatin C might improve risk prediction for poor
prognosis in AIS patients receiving rt-PA treatment.
