Prognostic Value of Cystatin C in Acute Ischemic Stroke Patients with Intravenous Thrombolysis

Association between initial serum cystatin C level and prognosis of aneurysmal subarachnoid hemorrhage

BACKGROUND

Aneurysmal subarachnoid hemorrhage (aSAH) patients usually suffer poor survival outcome and severe morbidity. Evaluating prognosis of aSAH patients in acute phase is essential for physicians to make suitable treatments strategies. This study was performed to explore the relation between initial serum cystatin C level and outcome of aSAH patients.

METHODS

Three hundred seven aSAH patients were included. Univariate and multivariate logistic regression were used to analyze the relationship between initial serum cystatin C level with mortality and unfavorable functional outcome of aSAH patients. Receiver operating characteristic curve (ROC) was drawn and area under the ROC curve (AUC) was calculated to evaluate the prognostic value of serum cystatin C in aSAH.

RESULTS

The incidence of mortality and unfavorable functional outcome in included 307 aSAH patients was 18.2% and 49.2%. Compared with survivors or patients with mRS < 3, non-survivors or those with mRS ≥ 3 had lower GCS and higher WFNS, Hunt-Hess, mFisher score. Serum cystatin C level was also higher in non-survivors or whose mRS ≥ than survivors or whose mRS < 3. Multivariate logistic regression showed serum cystatin C was significantly associated with mortality (p = 0.012) but not unfavorable functional outcome (p = 0.053) of aSAH. The AUC of serum cystatin C for predicting mortality and unfavorable functional outcome of aSAH patients was 0.718 and 0.669, respectively.

CONCLUSIONS

Initial serum cystatin C level is positively associated with mortality of aSAH patients. Evaluating serum cystatin C level is useful for clinicians to risk the severity of aSAH patients and therefore make personalized treatments regimen.

Changes in the Expression of Proteins Associated with Neurodegeneration in the Brains of Mice after Infection with Influenza A Virus with Wild Type and Truncated NS1

Influenza type A virus (IAV) infection is a major cause of morbidity and mortality during influenza epidemics. Recently, a specific link between IAV infection and neurodegenerative disease progression has been established. The non-structural NS1 protein of IAV regulates viral replication during infection and antagonizes host antiviral responses, contributing to influenza virulence. In the present study, we have prepared a mouse lung-to-lung adapted to the NS1-truncated virus (NS80ad). Transcriptome analysis of the gene expression in the lungs revealed that infection with wild-type A/WSN/33 (WSN), NS80, and NS80ad viruses resulted in different regulation of genes involved in signaling pathways associated with the cell proliferation, inflammatory response, and development of neurodegenerative diseases. NS1 protein did not influence the genes involved in the RIG-I-like receptor signaling pathway in the brains. Lethal infection with IAVs dysregulated expression of proteins associated with the development of neurodegenerative diseases (CX3CL1/Fractalkine, Coagulation factor III, and CD105/Endoglin, CD54/ICAM-1, insulin-like growth factor-binding protein (IGFBP)-2, IGFBP-5, IGFBP-6, chitinase 3-like 1 (CHI3L1), Myeloperoxidase (MPO), Osteopontin (OPN), cystatin C, and LDL R). Transcription of GATA3 mRNA was decreased, and expression of MPO was inhibited in the brain infected with NS80 and NS80ad viruses. In addition, the truncation of NS1 protein led to reduced expression of IGFBP-2, CHI3L1, MPO, and LDL-R proteins in the brains. Our results indicate that the influenza virus influences the expression of proteins involved in brain function, and this might occur mostly through the NS1 protein. These findings suggest that the abovementioned proteins represent a promising target for the development of potentially effective immunotherapy against neurodegeneration.

Serum cystatin C is correlated with mortality of traumatic brain injury patients partially mediated by acute kidney injury

BACKGROUND

Evaluating risk of poor outcome for Traumatic Brain Injury (TBI) in early stage is necessary to make treatment strategies and decide the need for intensive care. This study is designed to verify the prognostic value of serum cystatin C in TBI patients.

METHODS

415 TBI patients admitted to West China hospital were included. Logistic regression was performed to explore risk factors of mortality and testify the correlation between cystatin C and mortality. Mediation analysis was conducted to test whether Acute Kidney Injury (AKI) and brain injury severity mediate the relationship between cystatin C level and mortality. Area under the receiver operating characteristic curve (AUC) was used to evaluate the prognostic value of cystatin C and the constructed model incorporating cystatin C.

RESULTS

The mortality rate of 415 TBI patients was 48.9%. Non-survivors had lower GCS (5 vs 8, p < 0.001) and higher cystatin C (0.92 vs 0.71, p < 0.001) than survivors. After adjusting confounding effects, multivariate logistic regression indicated GCS (p < 0.001), glucose (p < 0.001), albumin (p = 0.009), cystatin C (p < 0.001) and subdural hematoma (p = 0.042) were independent risk factors of mortality. Mediation analysis showed both AKI and brain injury severity exerted mediating effects on relationship between cystatin C and mortality of included TBI patients. The AUC of combining GCS with cystatin C was 0.862, which was higher than that of GCS alone (Z = 1.7354, p < 0.05).

CONCLUSION

Both AKI and brain injury severity are mediating variables influencing the relationship between cystatin C and mortality of TBI patients. Serum cystatin C is an effective prognostic marker for TBI patients.

A nomogram based on serum cystatin C for predicting acute kidney injury in patients with traumatic brain injury

BACKGROUND

Acute kidney injury (AKI) is a common complication in traumatic brain injury (TBI) patients and is associated with unfavorable outcome of these patients. We designed this study to explore the value of serum cystatin C, an indicator of renal function, on predicting AKI after suffering TBI.

METHODS

Patients confirmed with TBI and hospitalized in the West China Hospital of Sichuan University between January 2015 and December 2019 were included. Patients were divided into two groups according to occurrence of AKI. Univariate and multivariate logistic regression analyses were sequentially utilized to find risk factors of AKI in included TBI patients. Nomogram composed of discovered risk factors for predicting AKI was constructed. Receiver operating characteristics (ROC) curves were drawn and area under the ROC curve (AUC) were calculated to evaluate the predictive value of cystatin C alone and the constructed nomogram.

RESULTS

Among 234 included TBI patients, 55 were divided into AKI group. AKI group had shorter length of stay (p < 0.001) and higher in-hospital mortality (p < 0.001). Multivariate logistic regression analysis showed absolute lymphocyte count (p = 0.034), serum creatinine (p < 0.001), serum cystatin C (p = 0.017) and transfusion of red blood cell (p = 0.005) were independently associated with development of AKI after TBI. While hypertonic saline use was not associated with the development of AKI (p = 0.067). The AUC of single cystatin C and predictive nomogram were 0.804 and 0.925, respectively.

CONCLUSION

Higher serum cystatin C is associated with development of AKI in TBI patients. Predictive nomogram incorporating cystatin C is beneficial for physicians to evaluate possibilities of AKI and consequently adjust treatment strategies to avoid occurrence of AKI.