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Inflammatory and metabolic markers and short-time outcome in patients with acute ischemic stroke in relation to TOAST subtypes

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Abstract

The aim of this study was to evaluate the association between inflammatory and metabolic markers and short-time outcome with acute ischemic stroke subtypes. A total of 121 patients was classified according to TOAST criteria, such as large artery atherosclerosis (LAAS), lacunar infarct (LAC), cardioembolic infarct (CEI), other determined etiology (ODE), and undetermined etiology (UDE). The functional impairment was evaluated within the first eight hours of stroke and the outcome after three-month follow-up using the modified Rankin Scale. Blood samples were obtained up to 24 h of stroke. Compared with 96 controls, patients with LAAS, CEI, and LAC subtypes showed higher levels of white blood cells, high-sensitivity C-reactive protein (hsCRP), interleukin 6 (IL-6), metalloproteinase 9 (MMP-9), glucose, and iron (p < 0.05); and lower high-density lipoprotein cholesterol (HDL-C) (p < 0.0001); platelets, insulin, insulin resistance, and homocysteine were higher in LAC (p < 0.0001); ferritin was higher in LAAS (p < 0.0001); and total cholesterol (TC) was lower in LAAS and CEI (p < 0.01). When stroke subtypes were compared, insulin was higher in LAAS vs. LAC and in LAC vs. CEI (p < 0.05); and TC was lower in LAAS vs. LAC (p < 0.05). Outcome and rate of mortality after three-month were higher in LAAS vs. LAC (p < 0.001 and p = 0.0391 respectively). The results underscored the important role of the inflammatory response and metabolic changes in the pathogenesis of ischemic stroke subtypes that might be considered on the initial evaluation of stroke patients to identify those that could benefit with individualized therapeutic strategies that taken into account these markers after acute ischemic event.

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Acknowledgments

The study was supported by Institutional Program for Scientific Initiation Scholarship (PIBIC) of the National Council for Scientific and Technological Development (CNPq); State University of Londrina (PROPPG); and Bayer HealthCare. We thank the University Hospital of State University of Londrina and HUTec Foundation for technical and administrative supports.

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The authors declare that they have no conflict of interests.

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Authors and Affiliations

  1. Health Sciences Postgraduate Program, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil

    Marcio Francisco Lehmann, Ana Paula Kallaur, Sayonara Rangel Oliveira, Daniela Frizon Alfieri, Franciele Delongui & Johnathan de Sousa Parreira

  2. Department of Clinical Surgery, Health Sciences Center, and Neurosurgery Service of the University Hospital, State University of Londrina, Londrina, Paraná, Brazil

    Marcio Francisco Lehmann

  3. Medicine Faculty, Health Sciences Center, State University of Londrina, Londrina, Paraná, Brazil

    Maria Caroline Martins de Araújo, Carolina Rossato, Jéssica Tavares de Almeida, Larissa Moliterno Pelegrino & Erick Frank Bragato

  4. Neurosciences Institute of Londrina, Londrina, Paraná, Brazil

    Ana Lucia Cruz Fürstenberger Lehmann

  5. Department of Pathology, Clinical Analysis, and Toxicology, Health Sciences Center, State University of Londrina, Av. Robert Koch, 60, CEP 86.038-440, Londrina, Paraná, Brazil

    Helena Kaminami Morimoto, Marcell Alysson Batisti Lozovoy, Andrea Name Colado Simão & Edna Maria Vissoci Reiche

  6. Department of Clinical Medicine, Health Sciences Center and Neurology Outpatient of the Outpatient Clinical Hospital, State University of Londrina, Londrina, Paraná, Brazil

    Damácio Ramon Kaimen-Maciel

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  1. Marcio Francisco Lehmann
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Lehmann, M.F., Kallaur, A.P., Oliveira, S.R. et al. Inflammatory and metabolic markers and short-time outcome in patients with acute ischemic stroke in relation to TOAST subtypes. Metab Brain Dis 30, 1417–1428 (2015). https://doi.org/10.1007/s11011-015-9731-8

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  • DOI: https://doi.org/10.1007/s11011-015-9731-8

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