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Early prognostic factors in ischemic stroke. The role of protein C and protein S
G P Anzola1, M Magoni, E Ascari
1Clinica Neurologica, Università di Brescia, Italy.
Insights
Low protein C levels in acute ischemic stroke patients indicate poor prognosis and higher mortality. The clinical significance of reduced free protein S requires further investigation.
Area of Science:
- Biochemistry
- Neurology
- Hematology
Background:
- Reduced levels of protein C and protein S have been observed in patients with ischemic cerebrovascular diseases.
- The prognostic relevance of these reduced levels in acute ischemic stroke remains unclear.
Purpose of the Study:
- To investigate the prognostic significance of reduced protein C and free protein S levels in patients with acute ischemic stroke.
- To determine if these protein levels correlate with stroke severity, cardiac comorbidities, or mortality.
Main Methods:
- Evaluated protein C and free protein S levels in 43 acute ischemic stroke patients upon admission and at 2 and 6 months post-stroke.
- Excluded patients with known conditions affecting protein C or free protein S levels.
- Assessed stroke severity using the Barthel and Canadian neurological scales and analyzed mortality and vascular risk factors.
Main Results:
- Abnormally low protein C levels were found in 14% of patients, associated with lower initial neurological scores, higher prevalence of cardiac diseases, and increased 6-month mortality.
- No significant differences in stroke severity, cardiac disease prevalence, mortality, or vascular risk factors were observed in patients with low free protein S levels (18.4%).
Conclusions:
- Low protein C levels in acute ischemic stroke appear to reflect significant coagulation activation and predict adverse outcomes.
- The prognostic value of low free protein S levels in this patient population warrants further research.
Background And Purpose:
Protein C and protein S have been found reduced in some patients with ischemic cerebrovascular diseases, but the relevance of this finding for prognosis is unsettled.
Methods:
In 43 consecutive patients admitted over 6 months for acute ischemic stroke, protein C and free protein S were evaluated on admission, and at 2 and 6 months after stroke. Excluded were all patients with known causes liable to reduce the levels of protein C, free protein S, or both.
Results:
In 14% of patients, abnormally low levels of protein C were found at entry. In comparison to the remaining sample, this group had a significantly lower initial score on the Barthel and Canadian neurological scales, a higher prevalence of emboligenic cardiac diseases, and had a higher mortality at 6 months. No statistical difference was found for the other vascular risk factors. Eight patients (18.4%) had abnormally low levels of free protein S at entry. In comparison to the remaining sample, there was no statistical difference in the severity scores, prevalence of emboligenic cardiac diseases, mortality, or vascular risk factors.
Conclusions:
These findings suggest that low levels of protein C in the acute stroke reflect the massive activation of coagulation factors and are predictive of adverse outcome, whereas the significance of low levels of free protein S remains to be clarified.