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Serum Caspase-3 Levels and Early Mortality of Patients with Malignant Middle Cerebral Artery Infarction

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Abstract

Purpose

Circulating caspase-3 levels at 24 h of ischemic stroke were found to be associated with poorer functional neurological outcome in a previous study. The aim of this study was to determine whether there is an association between serum caspase-3 levels and early mortality in patients with malignant middle cerebral artery infarction (MMCAI).

Methods

We included patients with MMCAI defined as computer tomography showing ischemic changes in more than 50% of the middle cerebral artery territory and Glasgow Coma Scale ≤ 8. Serum caspase-3 levels at days 1, 4, and 8 of MMCAI were determined.

Results

Non-surviving MMCAI (n = 34) showed higher serum caspase-3 levels at days 1 (p < 0.001), 4 (p = 0.001), and 8 (p = 0.01) than surviving patients (n = 34). We found that the area under the curve of serum caspase-3 levels for prediction of mortality at 30 days was 88% (95% CI = 78–95%; p < 0.001). Multiple logistic regression showed that serum caspase-3 levels were associated with 30-day mortality (OR = 51.25; 95% CI = 8.30–316.31; p < 0.001).

Conclusions

The novel and more important findings of our study were that high serum caspase-3 levels were associated with mortality in MMCAI patients.

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Abbreviations

APACHE:

Acute Physiology and Chronic Health Evaluation

aPTT:

Activated partial thromboplastin time

COPD:

Chronic obstructive pulmonary disease

FIO2 :

Fraction inspired of oxygen

GCS:

Glasgow Coma Scale

INR:

International normalized ratio

PaO2 :

Pressure of arterial oxygen

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Acknowledgements

This study was supported by a Grant (OA18/011) from Fundación DISA a la Investigación Médica 2017 (Santa Cruz de Tenerife. Spain). Funding did not have influence in the study design, the collection, analysis, and interpretation of data, the manuscript writing, and the decision to submit it for publication.

Funding

This study was supported by a grant (OA18/011) from Fundación DISA a la Investigación Médica 2017 (Santa Cruz de Tenerife. Spain).

Author information

Authors and Affiliations

  1. Intensive Care Unit, Hospital Universitario de Canarias, Ofra s/n, La Laguna, 38320, Santa Cruz de Tenerife, Spain

    Leonardo Lorente

  2. Intensive Care Unit, Hospital Universitario Nuestra Señora de Candelaria, Crta del Rosario s/n, 38010, Santa Cruz de Tenerife, Spain

    María M. Martín

  3. Laboratory Department, Hospital Universitario de Canarias, Ofra, s/n, La Laguna, 38320, Santa Cruz de Tenerife, Spain

    Antonia Pérez-Cejas & Agustín F. González-Rivero

  4. Department of Radiology, Hospital Universitario de Canarias, Ofra, s/n, La Laguna, 38320, Santa Cruz de Tenerife, Spain

    Rafael Sabatel

  5. Intensive Care Unit, Hospital General La Palma, Buenavista de Arriba s/n, Breña Alta, 38713, La Palma, Spain

    Luis Ramos

  6. Intensive Care Unit, Hospital Clínico Universitario de Valencia, Avda. Blasco Ibáñez nº17-19, 46004, Valencia, Spain

    Mónica Argueso

  7. Intensive Care Unit, Hospital Universitario Dr. Negrín, CIBERES, Barranco de la Ballena s/n, 35010, Las Palmas de Gran Canaria, Spain

    Jordi Solé-Violán

  8. Intensive Care Unit, Hospital Insular, Plaza Dr. Pasteur s/n, 35016, Las Palmas de Gran Canaria, Spain

    Juan J. Cáceres

  9. Research Unit, Hospital Universitario de Canarias, Ofra s/n, La Laguna, 38320, Santa Cruz de Tenerife, Spain

    Alejandro Jiménez

  10. Department of Neurosurgery, Hospital Universitario de Canarias, Ofra, s/n, La Laguna, 38320, Santa Cruz de Tenerife, Spain

    Victor García-Marín

Authors
  1. Leonardo Lorente
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  2. María M. Martín
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  6. Luis Ramos
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  9. Juan J. Cáceres
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  10. Alejandro Jiménez
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Contributions

LL conceived, designed and coordinated the study, participated in acquisition and interpretation of data, and drafted the manuscript. MMM, RS, LR, MA, JSV, JJC, and VGM participated in acquisition of data. APC and AFGR participated in blood determination levels. AJ participated in the interpretation of data. All authors revised the manuscript critically for important intellectual content, made the final approval of the version to be published, and agreed to be accountable for all aspects of the work.

Corresponding author

Correspondence to Leonardo Lorente.

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Conflicts of interest

The authors declare that they have no conflict of interests.

Ethical Approval/Informed Consent

This study was carried after the approval of Institutional Review Board of all participating hospitals and with the written informed consent from legal guardians of patients.

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Lorente, L., Martín, M.M., Pérez-Cejas, A. et al. Serum Caspase-3 Levels and Early Mortality of Patients with Malignant Middle Cerebral Artery Infarction. Neurocrit Care 31, 486–493 (2019). https://doi.org/10.1007/s12028-019-00739-y

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  • DOI: https://doi.org/10.1007/s12028-019-00739-y

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