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Prognostic significance of serum cystatin C in acute brainstem infarctions patients
1Department of Neurology, center for Mental and neurological disorders and Diseases, The Third Affiliated Hospital of Sun Yat-Sen University, No 600 Tianhe Road, Guangzhou, Guangdong, China.
Insights
Lower estimated glomerular filtration rate (eGFR) calculated with cystatin C (eGFRCysC) is linked to worse outcomes in brainstem infarction (BSI) patients. This finding suggests eGFRCysC may help predict prognosis in BSI survivors.
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.
Objectives:
Some studies show that high circulating cystatin C (CysC) may predict cardiovascular events and death after ischemic stroke onset. However, the association between serum CysC and outcome in ischemic stroke patients remains contradictory. We sought to assess the association between a specific stroke subgroup, brainstem infarction (BSI) and serum CysC.
Materials And Methods:
A total of 324 acute BSI patients were included in the study. Serum CysC was used to calculate estimated glomerular filtration rate (eGFRCysC) at baseline. Modified Rankin scale score ((mRS) ≥3) six months after acute BSI indicates poor functional outcome. Patients were categorized into two groups according to mRS and eGFRCysC. Logistic regression analyses were performed to determine independent risk factors.
Results:
Lower eGFRCysC was associated with hemoglobin A1c (HbA1c). This risk remained statistically significant after controlling for age, hypertension, initial National Institutes of Health Stroke Scale (NIHSS) score, HbA1c, fibrinogen and homocysteine. The serum eGFRCysC levels were significantly lower in the poor functional outcome group than the good functional outcome group (P<0.001). Multivariate logistic regression analyses showed that eGFRCysC level was significantly lower in the poor outcome group after adjusting for age, previous infarctions, initial NIHSS score, and HbA1c.
Conclusions:
Lower eGFRCysC levels were strongly associated with poor functional outcome of acute BSI patients with a higher HbA1c level. Lower eGFRCysC may be a more helpful serologic biomarker for the prediction of prognosis in BSI.
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