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Xu C, Yi T, Qing T, Jiang Y, Yi X, Xu J, Ma J. Serum neurofilament light chain: a predictive marker for outcomes following mild-to-moderate ischemic stroke. Front Neurol 2024; 15:1398826. [PMID: 38841696 PMCID: PMC11150679 DOI: 10.3389/fneur.2024.1398826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 05/02/2024] [Indexed: 06/07/2024] Open
Abstract
Background Biomarkers that reflect brain damage or predict functional outcomes may aid in guiding personalized stroke treatments. Serum neurofilament light chain (sNfL) emerges as a promising candidate for fulfilling this role. Methods This prospective, observational cohort investigation included 319 acute ischemic stroke (IS) patients. The endpoints were the incidence of early neurological deterioration (END, an elevation of two or more points in the National Institute of Health stroke scale score within a week of hospitalization compared with the baseline) and functional outcome at 3 months (an mRS score of >2 at 3 months was categorized as an unfavorable/poor functional outcome). The association of sNfL, which was assessed within 24 h of admission, with END and unfavorable functional outcomes at follow-up was assessed via multivariate logistic regression, whereas the predictive value of sNfL for unfavorable functional outcomes and END was elucidated by the receiver operating characteristic curve (ROC). Results Of 319 IS individuals, 89 (27.90%) suffered from END. sNfL not only reflects the severity of stroke measured by NIHSS score (p < 0.05) but also closely related to the severity of age-related white matter changes. Higher initial NIHSS score, severe white matter lesions, diabetes mellitus, and upregulated sNfL were significant predictors of END. Similarly, the multivariate logistic regression analysis results showed that elevated sNfL, a higher baseline NIHSS score, and severe white matter lesions were substantially linked with unfavorable outcomes for 3 months. Similarly, sNfL was valuable for the prediction of the 3 months of poor outcome (95%CI, 0.504-0.642, p = 0.044). Kaplan-Meier analysis shows that patients with elevated sNfL levels are more likely to reach combined cerebrovascular endpoints (log-rank test p < 0.05). Conclusion This investigation suggests that sNfL can serve as a valuable biomarker for predicting END and 3-month poor functional outcomes after an IS and has the potential to forecast long-term cardiovascular outcomes.
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Affiliation(s)
- Chongxi Xu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Tong Yi
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ting Qing
- Department of Neurology, The Second People’s Hospital of Deyang City, Deyang, Sichuan, China
| | - Yongliang Jiang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xingyang Yi
- Department of Neurology, People’s Hospital of Deyang City, Deyang, Sichuan, China
| | - Jianguo Xu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Junpeng Ma
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Derraz I, Abdelrady M, Ahmed R, Gaillard N, Morganti R, Cagnazzo F, Dargazanli C, Lefevre PH, Riquelme C, Corti L, Gascou G, Mourand I, Arquizan C, Costalat V. Impact of White Matter Hyperintensity Burden on Outcome in Large-Vessel Occlusion Stroke. Radiology 2022; 304:145-152. [PMID: 35348382 DOI: 10.1148/radiol.210419] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background White matter hyperintensity (WMH) has been linked to poor clinical outcomes after acute ischemic stroke. Purpose To assess whether the WMH burden on pretreatment MRI scans is associated with an increased risk for symptomatic intracranial hemorrhage (sICH) or poor functional outcome in patients with acute ischemic stroke treated with endovascular thrombectomy (EVT). Materials and Methods In this retrospective study, consecutive patients treated with EVT for anterior circulation acute ischemic stroke at a comprehensive stroke center (where MRI was the first-line pretreatment imaging strategy; January 2015 to December 2017) were included and analyzed. WMH volumes were assessed with semiautomated volumetric analysis at fluid-attenuated inversion recovery MRI by readers who were blinded to clinical data. The associations of WMH burden with sICH and 3-month functional outcome (modified Rankin Scale [mRS] score) were assessed. Results A total of 366 patients were included (mean age, 69 years ± 19 [SD]; 188 women [51%]). Median total WMH volume was 3.61 cm3 (IQR, 1.10-10.83 cm3). Patients demonstrated higher mRS scores with increasing WMH volumes (odds ratio [OR], 1.020 [95% CI: 1.003, 1.037] per 1.0-cm3 increase for each mRS point increase; P = .018) after adjustment for patient and clinical variables. There were no significant associations between WMH severity and 90-day mortality (OR, 1.007 [95% CI: 0.990, 1.024]; P = .40) or the occurrence of sICH (OR, 1.001 [95% CI: 0.978, 1.024]; P = .94). Conclusion Higher white matter hyperintensity burden was associated with increased risk for poor 3-month functional outcome after endovascular thrombectomy for large-vessel occlusive stroke. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Mossa-Basha and Zhu in this issue.
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Affiliation(s)
- Imad Derraz
- From the Departments of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.H.L., C.R., G.G., V.C.) and Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier 34295, France; and Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy (R.M.)
| | - Mohamed Abdelrady
- From the Departments of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.H.L., C.R., G.G., V.C.) and Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier 34295, France; and Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy (R.M.)
| | - Raed Ahmed
- From the Departments of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.H.L., C.R., G.G., V.C.) and Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier 34295, France; and Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy (R.M.)
| | - Nicolas Gaillard
- From the Departments of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.H.L., C.R., G.G., V.C.) and Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier 34295, France; and Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy (R.M.)
| | - Riccardo Morganti
- From the Departments of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.H.L., C.R., G.G., V.C.) and Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier 34295, France; and Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy (R.M.)
| | - Federico Cagnazzo
- From the Departments of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.H.L., C.R., G.G., V.C.) and Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier 34295, France; and Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy (R.M.)
| | - Cyril Dargazanli
- From the Departments of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.H.L., C.R., G.G., V.C.) and Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier 34295, France; and Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy (R.M.)
| | - Pierre-Henri Lefevre
- From the Departments of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.H.L., C.R., G.G., V.C.) and Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier 34295, France; and Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy (R.M.)
| | - Carlos Riquelme
- From the Departments of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.H.L., C.R., G.G., V.C.) and Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier 34295, France; and Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy (R.M.)
| | - Lucas Corti
- From the Departments of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.H.L., C.R., G.G., V.C.) and Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier 34295, France; and Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy (R.M.)
| | - Grégory Gascou
- From the Departments of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.H.L., C.R., G.G., V.C.) and Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier 34295, France; and Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy (R.M.)
| | - Isabelle Mourand
- From the Departments of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.H.L., C.R., G.G., V.C.) and Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier 34295, France; and Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy (R.M.)
| | - Caroline Arquizan
- From the Departments of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.H.L., C.R., G.G., V.C.) and Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier 34295, France; and Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy (R.M.)
| | - Vincent Costalat
- From the Departments of Neuroradiology (I.D., M.A., R.A., F.C., C.D., P.H.L., C.R., G.G., V.C.) and Neurology (N.G., L.C., I.M., C.A.), Hôpital Gui de Chauliac, Montpellier University Medical Center, 80 Avenue Augustin Fliche, Montpellier 34295, France; and Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy (R.M.)
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5
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Uphaus T, Bittner S, Gröschel S, Steffen F, Muthuraman M, Wasser K, Weber-Krüger M, Zipp F, Wachter R, Gröschel K. NfL (Neurofilament Light Chain) Levels as a Predictive Marker for Long-Term Outcome After Ischemic Stroke. Stroke 2019; 50:3077-3084. [DOI: 10.1161/strokeaha.119.026410] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Ischemic stroke causes major disability as a consequence of neuronal loss and recurrent ischemic events. Biomarkers predicting tissue damage or stroke recurrence might be useful to guide an individualized stroke therapy. NfL (neurofilament light chain) is a promising biomarker that might be used for this purpose.
Methods—
We used individual data of patients with an acute ischemic stroke and clinical long term follow-up. Serum NfL (sNfL) was quantified within 24 hours after admission and after 1 year and compared with other biomarkers (GDF15 [growth differentiation factor 15], S100, NT-proBNP [N-terminal pro-B-type natriuretic peptide], ANP [atrial natriuretic peptide], and FABP [fatty acid–binding protein]). The primary end point was functional outcome after 90 days and cerebrovascular events and death (combined cardiovascular end point) within 36 months of follow-up.
Results—
Two hundred eleven patients (mean age, 68.7 years; SD, ±12.6; 41.2% women) with median clinical severity on the National Institutes of Health Stroke Scale (NIHSS) score of 3 (interquartile range, 1–5) and long-term follow-up with a median of 41.8 months (interquartile range, 40.0–44.5) were prospectively included. We observed a significant correlation between sNfL and NIHSS at hospital admission (r=0.234;
P
<0.001). sNfL levels increased with the grade of age-related white matter changes (
P
<0.001) and were able to predict unfavorable clinical outcome (modified Rankin Scale score, ≥2) 90 days after stroke (odds ratio [OR], 1.562; 95% CI, 1.003–2.433;
P
=0.048) together with NIHSS (OR, 1.303; 95% CI, 1.164–1.458;
P
<0.001) and age-related white matter change rating (severe; OR, 3.326; 95% CI, 1.186–9.326;
P
=0.022). Similarly, sNfL was valuable for the prediction of the combined cardiovascular end point (OR, 2.002; 95% CI, 1.213–3.302;
P
=0.007), besides NIHSS (OR, 1.110; 95% CI, 1.000–1.232;
P
=0.049), diabetes mellitus (OR, 2.942; 95% CI, 1.306–6.630;
P
=0.005), and age-related white matter change rating (severe; OR, 4.816; 95% CI, 1.206–19.229;
P
=0.026) after multivariate regression analysis. Kaplan-Meier analysis revealed significantly more combined cardiovascular end points (18 [14.1%] versus 38 [45.8%], log-rank test
P
<0.001) during long-term follow-up in patients with elevated sNfL levels.
Conclusions—
sNFL is a valuable biomarker for functional independence 90 days after ischemic stroke and predicts cardiovascular long-term outcome.
Clinical Trial Registration—
URL:
http://www.isrctn.com
. Unique identifier: ISRCTN 46104198.
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Affiliation(s)
- Timo Uphaus
- From the Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Germany (T.U., S.B., S.G., F.S., M.M., F.Z., K.G.)
| | - Stefan Bittner
- From the Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Germany (T.U., S.B., S.G., F.S., M.M., F.Z., K.G.)
| | - Sonja Gröschel
- From the Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Germany (T.U., S.B., S.G., F.S., M.M., F.Z., K.G.)
| | - Falk Steffen
- From the Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Germany (T.U., S.B., S.G., F.S., M.M., F.Z., K.G.)
| | - Muthuraman Muthuraman
- From the Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Germany (T.U., S.B., S.G., F.S., M.M., F.Z., K.G.)
| | - Katrin Wasser
- Department of Neurology (K.W.), University of Göttingen, Germany
| | - Mark Weber-Krüger
- Department of Cardiology and Pneumology (M.W.-K.), University of Göttingen, Germany
| | - Frauke Zipp
- From the Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Germany (T.U., S.B., S.G., F.S., M.M., F.Z., K.G.)
| | - Rolf Wachter
- Department of Cardiology, University Hospital Leipzig, Germany (R.W.)
| | - Klaus Gröschel
- From the Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Germany (T.U., S.B., S.G., F.S., M.M., F.Z., K.G.)
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6
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Liu Y, Zhang M, Bao H, Zhang Z, Mei Y, Yun W, Zhou X. The efficacy of intravenous thrombolysis in acute ischemic stroke patients with white matter hyperintensity. Brain Behav 2018; 8:e01149. [PMID: 30378299 PMCID: PMC6305931 DOI: 10.1002/brb3.1149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 10/03/2018] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES We aimed to investigate effects of deep white matter hyperintensity (DWMH) and periventricular hyperintensity (PVH) on the efficacy of intravenous thrombolysis (IVT) in patients with acute ischemic stroke (AIS). METHODS A total of 113 AIS patients with WMH were categorized into the PVH group and the DWMH group according to the lesion location, with the division of two subgroups based on whether or not they received IVT treatment: the thrombolysis group and the control group. Kaplan-Meier analysis was used for proportional hazards of recurrent stroke. Further, multivariate Cox regression analysis was employed. RESULTS Of total patients, there were 62 PVH patients and 51 DWMH patients: 27 of PVH patients and 22 of DWMH patients received IVT, and the remaining patients only received routine treatment. DWMH patients had a higher risk of END (36.4% vs. 11.1%; p = 0.034) and HT (22.7% vs. 3.7%; p = 0.038) than PVH patients in the thrombolysis group. Moreover, DWMH patients undergoing IVT also had a higher risk of END (36.4% vs. 10.3%; x2 = 5.050; p = 0.025) and HT (22.7% vs. 3.4%; x2 = 4.664; p = 0.031) than DWMH patients without IVT. Again, PVH patients had a higher rate of recurrent stroke (20.0% vs. 3.4%; p = 0.034) than DWMH patients in the control group after 90-day follow-up. Kaplan-Meier analysis showed a significant difference in cumulative probability of no major endpoint events (p = 0.039). Further, multivariate Cox regression revealed that PVH is an independent risk factor for stroke recurrence in AIS patients after adjusting confounding factors. CONCLUSIONS The location of WMH is closely associated with the efficacy of IVT in AIS patients.
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Affiliation(s)
- Yanyan Liu
- Department of Neurology, Laboratory of Neurological Diseases, Changzhou No. 2 People's Hospital, The Affiliated Hospital of Nanjing Medical University, Changzhou, China.,The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Min Zhang
- Department of Neurology, Laboratory of Neurological Diseases, Changzhou No. 2 People's Hospital, The Affiliated Hospital of Nanjing Medical University, Changzhou, China
| | - Hanmo Bao
- Emergency Center of the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Zhixiang Zhang
- Department of Neurology, Laboratory of Neurological Diseases, Changzhou No. 2 People's Hospital, The Affiliated Hospital of Nanjing Medical University, Changzhou, China
| | - Yuqing Mei
- Department of Neurology, Laboratory of Neurological Diseases, Changzhou No. 2 People's Hospital, The Affiliated Hospital of Nanjing Medical University, Changzhou, China
| | - Wenwei Yun
- Department of Neurology, Laboratory of Neurological Diseases, Changzhou No. 2 People's Hospital, The Affiliated Hospital of Nanjing Medical University, Changzhou, China
| | - Xianju Zhou
- Department of Neurology, Laboratory of Neurological Diseases, Changzhou No. 2 People's Hospital, The Affiliated Hospital of Nanjing Medical University, Changzhou, China
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