Kim Tae Jung, Kang Min Kyoung, Jeong Han-Gil, Kim Chi Kyung, Kim Yerim, Nam Ki-Woong, Mo Heejung, An Sang Joon, Ko Sang-Bae, Yoon Byung-Woo
Department of Neurology, Seoul National University Hospital, Republic of Korea.
Department of Neurology, Korea University Guro Hospital, Republic of Korea.
Eur Stroke J. 2017 Mar;2(1):23-30. doi: 10.1177/2396987316677197. Epub 2016 Oct 26.
Cystatin C has been suggested as a sensitive marker of renal function. A high level of cystatin C is related to cardiovascular disease and stroke in elderly patients. We investigated the relationship between levels of cystatin C and early neurological deterioration with acute ischaemic stroke in elderly patients without chronic kidney disease.
We evaluated a total of 771 elderly patients (mean age, 72.2; male, 59.0%) without chronic kidney disease who were admitted following acute ischaemic stroke between March 2010 and January 2015. The patients were divided into four groups based on the quartiles of serum cystatin C values. Early neurological deterioration was defined as an increase of ≥2 points from the baseline National Institutes of Health Stroke Scale score during the 7 days following onset. We compared the clinical characteristics and cystatin C concentrations between patients with and without early neurological deterioration.
Eighty-six patients (11.2%) experienced early neurological deterioration. The percentage values of the higher (third and fourth) quartiles were significantly higher in the early neurological deterioration group (30.2% vs. 24.4% and 34.9% vs. 23.8%, = 0.002). After adjustment for covariates, higher cystatin C levels were independently associated with a higher risk of early neurological deterioration: odds ratio (95% confidence interval) for second quartile 1.59 (0.70-3.58), third quartile 2.75 (1.25-6.04), fourth quartile 3.12 (1.36-7.16); for trend 0.026.
This study demonstrated that cystatin C concentrations in elderly patients without chronic kidney disease were associated with early neurological deterioration following acute stroke. This suggests that cystatin C level could be a useful predictor for early neurological deterioration following acute stroke.
胱抑素C已被认为是肾功能的敏感标志物。高水平的胱抑素C与老年患者的心血管疾病和中风有关。我们研究了无慢性肾脏病的老年急性缺血性中风患者中胱抑素C水平与早期神经功能恶化之间的关系。
我们评估了2010年3月至2015年1月期间因急性缺血性中风入院的771例无慢性肾脏病的老年患者（平均年龄72.2岁；男性占59.0%）。根据血清胱抑素C值的四分位数将患者分为四组。早期神经功能恶化定义为发病后7天内美国国立卫生研究院卒中量表评分较基线增加≥2分。我们比较了有和没有早期神经功能恶化的患者的临床特征和胱抑素C浓度。
86例患者（11.2%）出现早期神经功能恶化。早期神经功能恶化组中较高（第三和第四）四分位数的百分比值显著更高（30.2%对24.4%以及34.9%对23.8%，P = 0.002）。在对协变量进行调整后，较高的胱抑素C水平与早期神经功能恶化风险较高独立相关：第二四分位数的比值比（95%置信区间）为1.59（0.70 - 3.58），第三四分位数为2.75（1.25 - 6.04），第四四分位数为3.12（1.36 - 7.16）；趋势P值为0.026。
本研究表明，无慢性肾脏病的老年患者的胱抑素C浓度与急性中风后的早期神经功能恶化有关。这表明胱抑素C水平可能是急性中风后早期神经功能恶化的有用预测指标。
