Immune-Inflammatory, Metabolic, Oxidative, and Nitrosative Stress Biomarkers Predict Acute Ischemic Stroke and Short-Ter
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ORIGINAL ARTICLE
Immune-Inflammatory, Metabolic, Oxidative, and Nitrosative Stress Biomarkers Predict Acute Ischemic Stroke and Short-Term Outcome Daniela Frizon Alfieri 1 & Marcio Francisco Lehmann 2 & Tamires Flauzino 1 & Maria Caroline Martins de Araújo 3 & Nicolas Pivoto 1 & Rafaele Maria Tirolla 1 & Andrea Name Colado Simão 1,4 & Michael Maes 5,6 & Edna Maria Vissoci Reiche 1,4 Received: 20 February 2020 / Revised: 15 April 2020 / Accepted: 24 April 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Immune-inflammatory, metabolic, oxidative, and nitrosative stress (IMO&NS) pathways and, consequently, neurotoxicity are involved in acute ischemic stroke (IS). The simultaneous assessment of multiple IMO&NS biomarkers may be useful to predict IS and its prognosis. The aim of this study was to identify the IMO&NS biomarkers, which predict short-term IS outcome. The study included 176 IS patients and 176 healthy controls. Modified Rankin scale (mRS) was applied within 8 h after IS (baseline) and 3 months later (endpoint). Blood samples were obtained within 24 h after hospital admission. IS was associated with increased white blood cell (WBC) counts, high sensitivity C-reactive protein (hsCRP), interleukin (IL-6), lipid hydroperoxides (LOOHs), nitric oxide metabolites (NOx), homocysteine, ferritin, erythrocyte sedimentation rate (ESR), glucose, insulin, and lowered iron, 25-hydroxyvitamin D [25(OH)D], total cholesterol, and high-density lipoprotein (HDL) cholesterol. We found that 89.4% of the IS patients may be correctly classified using the cumulative effects of male sex, systolic blood pressure (SBP), glucose, NOx, LOOH, 25(OH)D, IL-6, and WBC with sensitivity of 86.2% and specificity of 93.0%. Moreover, increased baseline disability (mRS ≥ 3) was associated with increased ferritin, IL-6, hsCRP, WBC, ESR, and glucose. We found that 25.0% of the variance in the 3-month endpoint (mRS) was explained by the regression on glucose, ESR, age (all positively), and HDLcholesterol, and 25(OH)D (both negatively). These results show that the cumulative effects of IMO&NS biomarkers are associated with IS and predict a poor outcome at 3-month follow-up. Keywords Ischemic stroke . Inflammatory biomarkers . Oxidative stress . IL-6 . Modified Rankin scale . Short-term outcome
* Edna Maria Vissoci Reiche [email protected]
Michael Maes [email protected]
Daniela Frizon Alfieri [email protected]
1
Laboratory of Research in Applied Immunology, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil
Marcio Francisco Lehmann [email protected]
2
Department of Clinical Surgery, Health Sciences Center, Neurosurgery Service of the University Hospital, State University of Londrina, Londrina, Paraná, Brazil
3
Neurology Postgraduate Program, University Hospital of State University of Londrina, Londrina, Paraná, Brazil
4
Department of Pathology, Clinical Analysis, and Toxicology, Health Sciences Center, State University of Londrina, Av. Robert Koch, 60
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