Possibilities of functional outcome prediction in patients with acute ischemic stroke, who did not receive reperfusion therapy

Purpose of the study was to identify potential predictors of functional outcome of patients in the acute period of ischemic stroke, who did not receive reperfusion therapy, based on discriminant analysis.
Materials and methods: 193 patients diagnosed with ischemic stroke (IS) in the carotid basin, who did not receive reperfusion therapy, were examined. The evaluation of 35 parameters was used to create a mathematical prediction model: demographic parameters; comorbidity; localization of IS; degree of white matter hyperintensity (WMH); focal size; degree of internal carotid artery stenosis; NIHSS; cognitive status (IQCODE, MoCA, Stroop, Bourdon, Luria tests); severity of motor, sensory and speech impairments, presence of hemineglect; IS subtype; serum concentrations of cytokines IL-1b, IL-16, TNFα, CXCL10, CXCL11, CXCL9, CXCL1, CXCL6, CCL11, CCL24, CCL15, CCL23. Disability scores (modified Rankin Scale, mRS) and severity of cognitive deficit (Dementia Rating Scale, CDR) on day 14 from the development of IS were considered as functional outcome (FO) parameters. The Python programming language and SciPy library were used for statistical processing.
Results: the number of patients with unfavorable/ relatively unfavorable outcome at day 14 from the development of IS according to mRS was 51 (26.4%), according to CDR scale — 65 (33.6%) people. Statistical analysis revealed correlations of FO index on the mRS scale with the presence of diabetes mellitus, localization of IS, IL-1b, CCL24 and CCL23 concentrations; on the CDR scale — with the degree of IQCODE, WMH, CXCL10 level, impaired memory, speech and perception functions.
Conclusion: perceptual, mnestic and speech disorders along with the presence of premorbid cognitive deficit, WMH, left-sided localization of IS in the middle cerebral artery basin, changes in IL-1b, CCL23, CCL24 and CXCL10 concentrations were identified as independent predictors of adverse functional outcome of the patient in the acute period of ischemic stroke, who did not receive reperfusion therapy.

1. Savello AV, Voznyuk IA, Babichev KN, Kandyba DV, Shenderov SV, Vlasenko SV, Saraev GB. A prognosis scale for functional outcome at discharge after endovascular thrombectomy in the carotid artery territory. S.S. Korsakov Journal of Neurology and Psychiatry. 2021;121(6):34–39 (In Russ.). https://doi.org/10.17116/jnevro202112106134

2. Rajashekar D, Hill MD, Demchuk AM, Goyal M, Fiehler J, Forkert ND. Prediction of Clinical Outcomes in Acute Ischaemic Stroke Patients: A Comparative Study. Front Neurol. 2021 May 6;12:663899. doi: 10.3389/fneur.2021.663899

3. Repina LA, Romanova TV, Poverennova IE, Murtazina AKh. A prognostic model for ischemic stroke outcome. Science and Innovations in Medicine. 2023;8(3):181–188 (In Russ.). doi: 10.35693/2500-1388-2023-8-3-181-188

4. Gusev V.V., Lvova O.А., Kovtun O.P., Shamalov N.А., Sergeev A.P., Sergeeva M.V., Medvedeva D.A. The options for prognosis of the outcome of ischemic stroke in young patients. Perm Medical Journal. 2024;41(2):87–95 (In Russ.). doi: 10.17816/pmj41287-95

5. Gardener H, Romano LA, Smith EE, Campo-Bustillo I, Khan Y, Tai S, Riley N, Sacco RL, Khatri P, Alger HM, Mac Grory B, Gulati D, Sangha NS, Olds KE, Benesch CG, Kelly AG, Brehaut SS, Kansara AC, Schwamm LH, Romano JG. Functional status at 30 and 90 days after mild ischaemic stroke. Stroke Vasc Neurol. 2022 Apr 26;7(5):375–80. doi: 10.1136/svn-2021-001333

6. Manchi MR, Venkatachalam AM, Atem FD, Stone S, Mathews AA, Abraham AM, Chavez AA, Welch BG, Ifejika NL. Effect of inpatient rehabilitation facility care on ninety day modifi ed Rankin score in ischemic stroke patients. J Stroke Cerebrovasc Dis. 2023 Jun;32(6):107109. doi: 10.1016/j.jstrokecerebrovasdis.2023.107109

7. Guzek Z, Dziubek W, Stefańska M, Kowalska J. Evaluation of the functional outcome and mobility of patients after stroke depending on their cognitive state. Sci Rep. 2024 Jan 17;14(1):1515. doi: 10.1038/s41598-024-52236-8

8. Heldner MR, Chalfi ne C, Houot M, Umarova RM, Rosner J, Lippert J, Gallucci L, Leger A, Baronnet F, Samson Y, Rosso C. Cognitive Status Predicts Return to Functional Independence After Minor Stroke: A Decision Tree Analysis. Front Neurol. 2022 Feb 17;13:833020. doi: 10.3389/fneur.2022.833020

9. Wu C, Qin Y, Lin Z, Yi X, Wei X, Ruan Y, He J. Prevalence and Impact of Aphasia among Patients Admitted with Acute Ischemic Stroke. J Stroke Cerebrovasc Dis. 2020 May;29(5):104764. doi: 10.1016/j.jstrokecerebrovasdis.2020.104764. Epub 2020 Mar 12. PMID: 32173230.

10. Seo KC, Ko JY, Kim TU, Lee SJ, Hyun JK, Kim SY. Post-stroke Aphasia as a Prognostic Factor for Cognitive and Functional Changes in Patients With Stroke: Ischemic Versus Hemorrhagic. Ann Rehabil Med. 2020 Jun;44(3):171–180. doi: 10.5535/arm.19096

11. Lau LH, Lew J, Borschmann K, Thijs V, Ekinci EI. Prevalence of diabetes and its effects on stroke outcomes: A meta-analysis and literature review. J Diabetes Investig. 2019 May;10(3):780–792. doi: 10.1111/jdi.12932

12. Voronina V.P., Zagrebelnyi A.V., Lukina Yu.V., Kutishenko N.P., Dmitrieva N.A., Lerman O.V., Lukyanov M.M., Okshina Е.Yu., Blagodatskikh S.V., Ivanova L.P., Boytsov S.А., Drapkina O.M., Martsevich S.Yu. Features of cerebral stroke course in patients with diabetes mellitus according to the REGION-M register. Cardiovascular Therapy and Prevention. 2019;18(5):60–65. (In Russ.). https://doi.org/10.15829/1728-8800-2019-5-60-65

13. Mizrahi EH, Fleissig Y, Arad M, Kaplan A, Adunsky A. Functional outcome of ischemic stroke: a comparative study of diabetic and non-diabetic patients. Disabil Rehabil. 2007 Jul 30;29(14):1091–5. doi: 10.1080/09638280600929177

14. Ershov VI, Chirkov AN, Gonchar-Zaykin AP, Lyashchenko SN, Lozinskaya TY, Gumalatova NV, Kuznetsov GE, Tenchurina LR. Mathematical modeling of ischemic stroke. Neurology, Neuropsychiatry, Psychosomatics. 2019;11(4):38–43 (In Russ.). https://doi.org/10.14412/2074-2711-2019-4-38-43

15. Gwak DS, Ryu WS, Schellingerhout D, Chung J, Kim HR, Jeong SW, Kim BJ, Kim JT, Hong KS, Park JM, Park MS, Choi KH, Park TH, Lee K, Park SS, Kang K, Cho YJ, Park HK, Lee BC, Yu KH, Oh MS, Lee SJ, Kim JG, Cha JK, Kim DH, Lee J, Han MK, Lee JS, Bae HJ, Kim DE. Effects of white matter hyperintensity burden on functional outcome after mild versus moderate-to-severe ischemic stroke. Sci Rep. 2024 Sep 29;14(1):22567. doi: 10.1038/s41598-024-71936-9

16. Serebrennikova S.N., Seminskу I.Z., Guzovskaija E.V., Gutsol L.O. Inflammation as a fundamental pathological process: Lecture 1 (alteration, vascular reactions). Baikal Medical Journal. 2023;2(2):53–64. (In Russ.). doi: 10.57256/2949-0715-2023-2-2-53-64

17. Claypoole SM, Frank JA, Messmer SJ, Pennypacker KR. CCR3 Expression in Relation to Delayed Microbleeds in a Rat Model of Large Vessel Occlusion. J Exp Neurol. 2024;5(1):1–8. doi: 10.33696/neurol.5.082

18. Wang X, Yang Y, Zhao Z, Li P, Ma C, Zhu B. Diagnostic Value of Serum MIF and CCL23 in the Patients with Acute Cerebral Infarction. Clin Lab. 2020 Nov 1;66(11). doi: 10.7754/Clin.Lab.2020.200239

19. Klimiec-Moskal E, Koceniak P, Weglarczyk K, Slowik A, Siedlar M, Dziedzic T. Circulating Chemokines and Short- and Long- Term Outcomes After Ischemic Stroke. Mol Neurobiol. 2024 Jun 11. doi: 10.1007/s12035-024-04279-1

20. Zhou F, Sun Y, Xie X, Zhao Y. Blood and CSF chemokines in Alzheimer’s disease and mild cognitive impairment: a systematic review and meta-analysis. Alzheimers Res Ther. 2023 Jun 8;15(1):107. doi: 10.1186/s13195-023-01254-1