Prognostic significance of serum cystatin C in acute brainstem infarctions patients

Area of Science:

• Neurology
• Nephrology
• Cardiovascular Medicine

Background:

• Circulating cystatin C (CysC) is a potential biomarker for cardiovascular events and mortality post-ischemic stroke.
• Previous studies show conflicting associations between serum CysC and outcomes in ischemic stroke patients.
• Brainstem infarction (BSI) represents a specific stroke subgroup where CysC's prognostic value requires clarification.

Purpose of the Study:

• To investigate the association between serum CysC-based estimated glomerular filtration rate (eGFRCysC) and functional outcomes in acute brainstem infarction (BSI) patients.
• To determine if eGFRCysC is an independent predictor of poor functional outcome after BSI.

Main Methods:

• A cohort of 324 patients with acute BSI was analyzed.
• Serum CysC was used to calculate baseline eGFR (eGFRCysC).
• Functional outcome was assessed using the modified Rankin Scale (mRS) at six months post-stroke (mRS ≥3 indicating poor outcome).
• Logistic regression analyses identified independent risk factors for poor functional outcome.

Main Results:

• Lower eGFRCysC levels were significantly associated with poor functional outcome (mRS ≥3) in BSI patients (P<0.001).
• This association remained significant after adjusting for age, previous infarctions, NIHSS score, and HbA1c.
• Lower eGFRCysC was also associated with higher hemoglobin A1c (HbA1c) levels.

Conclusions:

• Reduced eGFRCysC is strongly linked to poor functional outcomes in acute BSI patients, particularly those with elevated HbA1c.
• eGFRCysC may serve as a valuable serologic biomarker for predicting prognosis in patients with brainstem infarction.