Predictive Markers of Functional Outcome in Subtypes of Ischemic Stroke

The aim of the study was to identify potential predictors of functional outcome (FO) in patients with subtypes of ischemic stroke (IS) who did not receive reperfusion therapy.

Materials and methods. A prospective study included 229 patients with ischemic stroke divided . into three groups based on the IS subtype: Group 1 — 84 patients with cardioembolic IS; Group 2 — 65 patients with atherothrombotic IS; Group 3 — 80 patients with lacunar IS. Changes in the modified Rankin Scale (mRS) scores were considered as FO criteria calculated as the difference between the scores on admission and on the 21^st day after IS onset — ∆mRS. In order to optimize the performance of the machine learning (ML) model, a binary FO approach was chosen for assessment on the 21^st day after IS onset: mRS ≥ 3 scores corresponded to an unfavorable non-lethal outcome, and mRS = 0–2 scores corresponded to a favorable FO. We analyzed the interrelation with FO (correlation coefficient, r) and the predictive ability (ML (decision tree), information gain, i. g.) of 29 parameters, including demographic features; comorbidities; instrumental examination findings; NIHSS, BI, CDR scores; serum concentrations of cytokines on the 2^nd day of hospital stay.

Results. The following significant (P<0.0001) predictors of unfavorable non-lethal FO were identified: female sex (i. g. = 0.346), recurrent IS (i. g = 0.248), diabetes mellitus (i. g. = 0.442), and CXCL2 concentration (i.g. = 0.306) in Group 1; WMHs severity (i. g. = 0.206), diabetes mellitus (i. g. = 0.340), content of CCL2 (i. g. = 0.116), CCL3 (i. g. = 0.202) and CCL23 (i. g. = 0.101) in Group 2; age (i. g. = 0.106), 2^nd –3^rd degree obesity (i. g. = 0.150), WMHs severity (i. g. = 0.300), CXCL5 content (i. g. = 0.143) and MIF (i. g. = 0.145) in Group 3. Concentrations of CCL25 (i. g. = 0.108) and IL-6 (i. g. = 0.401) were found as predictors of favorable FO (P<0.0001) in Group 1; 1^st degree obesity (i. g. = 0.118) and TNF-α concentration (i. g. = 0.211) in Group 2; arterial hypertension (AH) (i. g. = 0.113) and 1^st degree obesity in Group 3.

Conclusion. Study results made evident the variances in combination of factors affecting FO, depending on IS pathogenetic subtype. Despite undoubtful value of the data obtained, further research is needed to expand the potentiality in predicting acute IS outcome and confirm the relevance of identified markers.

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