Moléculas inflamatorias y marcadores de lesión endotelial en la isquemia cerebral : participación en el deterioro neurológico y la transformación hemorrágiaca

Consultable des del TDXTítol obtingur de la portada digitalitzadaLos mecanismos implicados en el deterioro neurológico precoz (DNP) y en la transformación hemorrágica (TH) de la lesión isquémica cerebral no se conocen con exactitud. Estudios previos habían demostrado la asociación de niveles elevados de TNF-a e IL-6 con el DNP en pacientes con isquemia cerebral independientemente del mecanismo ictal. Sin embargo, los mecanismos relacionados con el DNP en pacientes con infarto lacunar no se conocían con exactitud. Con el objetivo de determinar si los mecanismos inflamatorios participaban en la progresión y el pronóstico funcional de estos pacientes se determinaron los niveles de TNF-a, IL-6 e ICAM-1 en el momento del ingreso en 113 pacientes con ictus lacunar de 14 pg/mL y de ICAM-1 > 208 pg/mL se asociaban de manera independiente tanto con el DNP como con el mal pronóstico funcional evaluado a los 3 meses. En cuanto a la TH, se había demostrado la asociación de niveles elevados de MMP-9 y la aparición de TH exclusivamente en pacientes con ictus de mecanismo cardioembólico por lo que se analizaron los niveles de esta molécula en 250 pacientes con ictus hemisférico de 14 pg/mL and ICAM-1 > 208 pg/mL were independently associated with both END and poor outcome at 3 months. On the other hand, the association between high levels of matrix metaloproteinase-9 (MMP-9) and secondary bleeding in patients with cardiembolic ischemic stroke had been already published. However, there were no data about the HT predictive capacity of MMP-9 in patients with other stroke subtypes. The association between high levels of MMP-9 and the development of HT was determined in 250 patients with hemispheric ischemic stroke within the first 24 hours of symptoms' onset. The results demonstrated that those patients with HT had significantly higher levels of MMP-9 at admission compared to those without secondary bleeding. Logistic regression analysis showed that MMP-9 levels ≥ 140 ng/mL were independently associated with HT after adjustment for potential confounders. Moreover, MMP-9 levels ≥ 140 ng/mL predicted the development of HT with a sensitivity, especificity, negative predictive value (NPV) and positive predictive value (PPV) of 87%, 90%, 61% and 97%, respectively. Finally, the association between the levels of cellular-Fibronectin (c-Fn), taken as a more specific marker of endothelial damage, and the development of HT in 87 patients who received thrombolytic treatment with rt-PA was evaluated. In order to compare the predictive capacity of MMP-9 and c-Fn levels, the levels of MMP-9 were also analyzed in this group of patients. The results demonstrated that patients with HT had significantly higher c-Fn as well as MMP-9 levels before the administration of the treatment. The levels of c-Fn were also higher in patients with symptomatic HT whereas no differences were found in MMP-9 levels between symptomatic and asymptomatic HT. Logistic regression analysis showed that c-Fn levels was the only variable associated with HT development after adjustment of potential confounders, which included MMP-9 levels. Levels of c-Fn ≥ 3.6 µg/mL predicted the development of hemorrhagic infarction type 2 and parenchymal hemorrhage (types of HT that has been reported to occur more often in patients treated with rt-PA) with a sensitivity of 100%, specificity of 96%, NPV of 44% and PPV of 100%, whereas the sensitivity, specificity, NPV and PPV of MMP-9 levels ≥ 140 ng/mL were 81%, 88%, 41% and 98%, respectively. These results were observed both in patients treated within 6 hours and within 3 hours from symptoms' onset. In conclusion, the results suggest that inflammation contributes to brain injury in patients with lacunar stroke and confirm that high plasma MMP-9 concentration is an independent predictor of HT in patients with acute ischemic stroke. Moreover, high plasma c-Fn levels are significantly associated with subsequent HT in stroke patients treated with rt-PA, so plasma c-Fn determinations might be useful in clinical practice to improve the risk/benefit ratio of thrombolytic treatment

Consensus document for lipid profile determination and reporting in Spanish clinical laboratories

Las enfermedades cardiovasculares (ECV) siguen siendo la principal causa de muerte en nuestro país. El control adecuado de las alteraciones del metabolismo lipídico es un reto clave en prevención cardiovascular que está lejos de alcanzarse en la práctica clínica real. Existe una gran heterogeneidad en los informes del metabolismo lipídico de los laboratorios clínicos españoles, lo que puede contribuir al mal control del mismo. Por ello, un grupo de trabajo de las principales sociedades científicas implicadas en la atención de los pacientes de riesgo vascular hemos elaborado este documento con una propuesta básica de consenso sobre la determinación del perfil lipídico básico en prevención cardiovascular, recomendaciones para su realización y unificación de criterios para incorporar los objetivos de control lipídico adecuados al riesgo vascular de los pacientes en los informes de laboratorio.Cardiovascular diseases (CVD) continue to be the main cause of death in our country. Adequate control of lipid metabolism disorders is a key challenge in cardiovascular prevention that is far from being achieved in real clinical practice. There is a great heterogeneity in the reports of lipid metabolism from Spanish clinical laboratories, which may contribute to its poor control. For this reason, a working group of the main scientific societies involved in the care of patients at vascular risk, has prepared this document with a consensus proposal on the determination of the basic lipid profile in cardiovascular prevention, recommendations for its realization and unification of criteria to incorporate the lipid control goals appropriate to the vascular risk of the patients in the laboratory reports

Impact of COVID-19 outbreak on ischemic stroke admissions and in-hospital mortality in North-West Spain

Background and purpose Spain has been one of the countries heavily stricken by COVID-19. But this epidemic has not affected all regions equally. We analyzed the impact of the COVID-19 pandemic on hospital stroke admissions and in-hospital mortality in tertiary referral hospitals from North-West Spain.Methods Spanish multicenter retrospective observational study based on data from tertiary hospitals of the NORDICTUS network. We recorded the number of patients admitted for ischemic stroke between 30 December 2019 and 3 May 2020, the number of IVT and EVT procedures, and in-hospital mortality.Results In the study period, 2737 patients were admitted with ischemic stroke. There was a decrease in the weekly mean admitted patients during the pandemic (124 vs. 173, p<0.001). In-hospital mortality of stroke patients increased significantly (9.9% vs. 6.5%, p = 0.003), but there were no differences in the proportion of IVT (17.3% vs. 16.1%, p = 0.405) or EVT (22% vs. 23%, p = 0.504).Conclusion We found a decrease in the number of ischemic stroke admissions and an increase in in-hospital mortality during the COVID-19 epidemic in this large study from North-West Spain. There were regional changes within the network, not fully explained by the severity of the pandemic in different regions.Peer reviewe

Association of High Serum Levels of Growth Factors with Good Outcome in Ischemic Stroke: a Multicenter Study

The main objective of this research work was to study the association of serum levels of growth factors (GF) and SDF-1alpha with the functional outcome and reduction of lesion volume in ischemic stroke patients. In this multicenter study, 552 patients with non-lacunar stroke (male, 62.1%; mean age, 68.2 +/- 11.4) were included within 24 h from symptom onset. The main outcome variable was good functional outcome (modified Rankin Scale [mRS] </= 2) at 12 months. Secondary outcome variable was infarct volume (in mL) after 6 +/- 3 months. Serum levels of VEGF, Ang-1, G-CSF, BDNF, and SDF-1alpha were measured by ELISA at admission, 7 +/- 1 days, at 3 +/- 1 months, and 12 +/- 3 months. Except for BDNF, all GF and SDF-1alpha serum levels showed a peak value at day 7 and remained elevated during the first 3 months (all p < 0.01). High serum levels at day 7 of VEGF (OR, 19.3), Ang-1 (OR, 14.7), G-CSF (OR, 9.6), and SDF-1alpha (OR, 28.5) were independently associated with good outcome at 12 months (all p < 0.0001). On the other hand, serum levels of VEGF (B, - 21.4), G-CSF (B, - 14.0), Ang-1 (B, - 13.3), and SDF-1alpha (B, - 44.6) measured at day 7 were independently associated with lesion volume at 6 months (p < 0.01). In summary, high serum levels of VEGF, Ang-1, G-CSF, and SDF-1alpha at day 7 and 3 months after ischemic stroke are associated with good functional outcome and smaller residual lesion at 1 year of follow-up

Oral Anticoagulation and Risk of Symptomatic Hemorrhagic Transformation in Stroke Patients Treated With Mechanical Thrombectomy: Data From the Nordictus Registry

Introduction: We aimed to evaluate if prior oral anticoagulation (OAC) and its type determines a greater risk of symptomatic hemorrhagic transformation in patients with acute ischemic stroke (AIS) subjected to mechanical thrombectomy. Materials and Methods: Consecutive patients with AIS included in the prospective reperfusion registry NORDICTUS, a network of tertiary stroke centers in Northern Spain, from January 2017 to December 2019 were included. Prior use of oral anticoagulants, baseline variables, and international normalized ratio (INR) on admission were recorded. Symptomatic intracranial hemorrhage (sICH) was the primary outcome measure. Secondary outcome was the relation between INR and sICH, and we evaluated mortality and functional outcome at 3 months by modified Rankin scale. We compared patients with and without previous OAC and also considered the type of oral anticoagulants. Results: About 1.455 AIS patients were included, of whom 274 (19%) were on OAC, 193 (70%) on vitamin K antagonists (VKA), and 81 (30%) on direct oral anticoagulants (DOACs). Anticoagulated patients were older and had more comorbidities. Eighty-one (5.6%) developed sICH, which was more frequent in the VKA group, but not in DOAC group. OAC with VKA emerged as a predictor of sICH in a multivariate regression model (OR, 1.89 [95% CI, 1.01-3.51], p = 0.04) and was not related to INR level on admission. Prior VKA use was not associated with worse outcome in the multivariate regression model nor with mortality at 3 months. Conclusions: OAC with VKA, but not with DOACs, was an independent predictor of sICH after mechanical thrombectomy. This excess risk was associated neither with INR value by the time thrombectomy was performed, nor with a worse functional outcome or mortality at 3 months

Documento de consenso para la determinación e informe del perfil lipídico en laboratorios clínicos españoles: ¿Qué parámetros debe incluir un perfil lipídico básico?

Las enfermedades cardiovasculares (ECV) siguen siendo la principal causa de muerte en nuestro país. El control adecuado de las alteraciones del metabolismo lipídico es un reto clave en prevención cardiovascular que está lejos de alcanzarse en la práctica clínica real. Existe una gran heterogeneidad en los informes del metabolismo lipídico de los laboratorios clínicos españoles, lo que puede contribuir al mal control del mismo. Por ello, un grupo de trabajo de las principales sociedades científicas implicadas en la atención de los pacientes de riesgo vascular hemos elaborado este documento con una propuesta básica de consenso sobre la determinación del perfil lipídico básico en prevención cardiovascular, recomendaciones para su realización y unificación de criterios para incorporar los objetivos de control lipídico adecuados al riesgo vascular de los pacientes en los informes de laboratorio

Consensus document for lipid profile testing and reporting in Spanish clinical laboratories: what parameters should a basic lipid profile include?

Cardiovascular diseases (CVD) continue to be the main cause of death in our country. Adequate control of lipid metabolism disorders is a key challenge in cardiovascular prevention that is far from being achieved in real clinical practice. There is a great heterogeneity in the reports of lipid metabolism from Spanish clinical laboratories, which may contribute to its poor control. For this reason, a working group of the main scientific societies involved in the care of patients at vascular risk, has prepared this document with a consensus proposal on the determination of the basic lipid profile in cardiovascular prevention, recommendations for its realization and unification of criteria to incorporate the lipid control goals appropriate to the vascular risk of the patients in the laboratory reports

Impact of COVID‐19 outbreak in reperfusion therapies of acute ischemic stroke in North‐West Spain

Since the first reported case in early December 2019, severe acute respiratory coronavirus 2 (SARS‐CoV‐2) infection, known as Coronavirus Disease 2019 (COVID‐19), has spread all over the world (1‐3). As of June 4th, more than 6 million cases and 350,000 deaths have been reported worldwide (4). Treating these patients and containing the outbreak has become the main priority in any center, arising the risk of possible collateral damage on patients with other acute diseases due to the collapse of the pre‐ and intra‐hospital emergency care systems.Peer reviewe