Serum Cystatin C Levels Affect The Prognosis Of Acute Ischemic Stroke Patients Treated With Edaravone

Objective: Aming to observe the changes of serum Cystatin C(CysC)level in patients with acute ischemic stroke,investigate the correlation between serum CysC level and the prognosis of stroke,and determine whether serum CysC level affects the clinical prognosis of patients with acute ischemic stroke treated with Edaravone.Methods: Continuously collect 161 cases of patients with acute ischemic stroke admitted to the department of Northern Jiangsu People’s Hospital from June,2018 to December,2019.General demographic data,stroke risk factors,previous medical history,time from onset to admission,blood pressure at admission,and laboratory examination indexes were collected for each patient,and the CysC level in fasting peripheral venous blood on the morning after admission of the patients was detected by latex enhanced immune turbidimetric method.Treatment options for patients with acute ischemic stroke,including intravenous thrombolysis and/or intravascular thrombolysis,and the use of Edaravone,were jointly determined by two attending physicians and above in accordance with the Chinese guidelines for the diagnosis and treatment of acute ischemic stroke.Patients who received Edaravone treatment only once upon admission were also considered to have received Edaravone treatment.The National Institutes of Health Stroke Score scale(NIHSS)was used to assess the degree of initial neurological impairment at admission,and the modified Rankin Scale score(mRS)was used to assess the prognosis at 30 d and 90 d.Subsequently,mRS≤2 was identified as a group with good prognosis,and mRS>2 as a group with poor prognosis.The general data of the two groups were compared,and the influencing factors of the prognosis of patients with acute ischemic stroke were determined by binary multivariate Logistic regression analysis.Patients were divided into the high CysC group(>0.91mg/L)and the low CysC group(≤0.91mg/L)according to the median CysC,and the correlation between serum CysC level and the prognosis at 30 and 90 days was analyzed.The patients receiving treatment with Edaravone were in the Edaravone group,and the patients without Edaravone were in the control group.The Cochran-Mantel-Haenszel method was used to detect the influence of CysC on the prognosis of the two subgroups,and further binary multivariate Logistic regression analysis was performed on the two subgroups.P < 0.05 was considered statistically significant.Results:(1)The age,onset to admission time,creatinine,CysC,lipoprotein-a of patients in Edaravone group was lower than the control group(P<0.05).And the prevalence of hyperlipidemia,systolic blood pressure,LDL-C,glutamate transaminase,alanine transaminase,neutrophils,NIHSS score at admission,and the proportion of intravenous thrombolysis were all higher than those of the control group(P<0.05).There was no significant difference in the proportion of good prognosis and mRS score between Edaravone group and control group on day 30 and day 90(P>0.05).(2)The age,incidence of atrial fibrillation and coronary heart disease in the patients with poor prognosis was higher than that in the patients with good prognosis,with statistically significant differences(P<0.05).The levels of triglyceride and homocysteine in the group with poor prognosis were lower than those in the group with good prognosis,and the difference was statistically significant(P<0.05).Compared with the group with good prognosis,there are more patients in the group with poor prognosis received arterial thrombectomy(P=0.006),and had higher NIHSS score at admission(P<0.001)and longer hospitalization time(P=0.021),with statistically significant differences.(3)The logistic regression analysis showed that increased NIHSS score,increased cystatin C level and prolonged hospitalization were independently correlated with poor prognosis in patients with ischemic stroke after adjusting for other factors,with statistically significant differences(P<0.05).Compared with low levels of cystatin C,patients with high levels of cystatin C had an increased risk of poor prognosis(OR=7.708,95%CI: 1.835-27.298,P=0.004).(4)More patients with good prognosis(mRS≤2)in the low CysC group at 90 days than in the high CysC group(P=0.006),and higher CysC level was associated with higher mRS score at 90 days(P=0.018).However,CysC level was not associated with mRS score and good prognosis at 30 days,and the difference was not statistically significant(P>0.05).(5)The Cochran-Mantel-Haenszel test revealed a significant difference(P=0.006)in the effects of CysC on 90-day outcomes of patients with and without Edaravone treatment.In patients receiving Edaravone treatment(Edaravone group),high CysC level was associated with poor prognosis at 90 days,with a statistically significant difference(9.7%vs29%,P=0.017),while in patients receiving no Edaravone treatment(control group),high CysC level was not associated with poor prognosis at 90 days(18.8%vs29.5%,P=0.403).(6)The logistic regression analysis in the subgroup showed that in Edaravone group,higher cystatin C level was positively correlated with poor prognosis(mRS>2)(OR=7.445,95%CI: 1.833-30.241,P=0.005),but not in the control group(OR=1.521,95%CI: 0.256-9.049,P=0.645).Conclusion:(1)CysC was independently associated with the outcome of patients with ischemic stroke at 90 days,and higher CysC levels predicted an increased risk of poor prognosis,whereas CysC was not associated with the outcome at 30 days.(2)In Edaravone group,high levels of CysC were associated with poor prognosis in patients with ischemic stroke,while not in control group,suggesting that CysC may have an impact on the effect of Edaravone.