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Oxidative stress and early mortality in acute ischemic stroke: A prospective cohort study
Eman A Elhamrawy1, Heba Shoman2, Hayam Abdel-Tawab1
1Department of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Background:
Malondialdehyde (MDA) is an oxidative stress biomarker, which represents a unifying mechanism of brain injury that occurs throughout the ischemic stroke cascade. The current study aimed to examine whether or not acute ischemic stroke (AIS) patients who had elevated serum MDA levels at admission had an increased risk of mortality and a worse functional outcome three months later.
Methods:
An observational, prospective cohort study that enrolled 90 patients with AIS. The patients were examined in the first 24 hours and then followed up for three months to assess mortality, short-term neurological functional outcome, and neurological disability by the Modified Rankin Scale (MRS).
Results:
The mean of serum MDA level among AIS patients was 6.3 ± 3.7 nmol/ml. Non-survivor cases were associated with statistically significantly higher serum MDA levels compared to survivors (9.7 ± 4.3 vs. 5.3 ± 2.8, p < 0.001), respectively. Patients with severe stroke, according to NIHSS score, were associated with significantly (p < 0.05) higher MDA levels compared to moderate and mild cases (7.4 ± 4.3 vs. 5.4 ± 2.6 vs. 3.3 ± .6). At a cutoff point of ≥ 6.7 nmol/ml, the area under the curve (AUC) for serum MDA levels as a predictor of mortality was 0.8 (0.69-0.91; p < 0.05). The sensitivity, specificity, positive predictive value, and negative predictive value were 77%, 80%, 89.5%, and 48.5%, respectively. Multivariate regression demonstrated that MDA level was a significant independent predictor of mortality among patients with AIS (OR = 1.29, 95% CI: 1.01 to 1.65; p = 0.041).
Conclusion:
MDA serum level was significantly higher in non-survivors than in survivors patients, so MDA could be used as a predictor for early mortality and short-term outcome of cases with AIS.
Insights
Elevated serum malondialdehyde (MDA) levels in acute ischemic stroke (AIS) patients predict higher mortality risk and worse outcomes. MDA serves as a crucial biomarker for early risk assessment in AIS patients.
Area of Science:
- Neurology
- Biomarkers
- Oxidative Stress
Background:
- Malondialdehyde (MDA) is a key biomarker of oxidative stress implicated in brain injury during ischemic stroke.
- Elevated MDA levels may indicate increased risk and poorer outcomes in acute ischemic stroke (AIS) patients.
Purpose of the Study:
- To investigate the association between elevated serum MDA levels at admission and mortality risk in AIS patients.
- To evaluate the correlation between serum MDA levels and short-term functional outcomes at three months post-AIS.
Main Methods:
- Prospective observational cohort study involving 90 AIS patients.
- Serum MDA levels measured within 24 hours of admission.
- Patients followed for three months to assess mortality and functional outcomes using the Modified Rankin Scale (MRS).
Main Results:
- Non-survivors exhibited significantly higher serum MDA levels (9.7 ± 4.3 nmol/ml) compared to survivors (5.3 ± 2.8 nmol/ml).
- Severe AIS cases showed significantly higher MDA levels than moderate and mild cases.
- Serum MDA levels (≥ 6.7 nmol/ml) predicted mortality with 80% specificity and 77% sensitivity (AUC=0.8).
- MDA level was an independent predictor of mortality in AIS patients (OR=1.29, p=0.041).
Conclusions:
- Higher serum MDA levels in AIS patients are significantly associated with increased mortality.
- Serum MDA can serve as a valuable predictor for early mortality and short-term outcomes in AIS.
