Evaluation of Serum Allopregnanolone Levels in Acute Stroke Patients Presenting to The Emergency Department and Undergoing Mechanical Thrombectomy

Abstract

Objectives: Ischemic stroke is a disease that occurs as a result of impaired perfusion of the brain and is the second most common cause of death after cardiovascular diseases. Biochemical marker studies for early diagnosis of stroke patients and predicting the prognosis of patients have been the focus of the attention of researchers. Our primary aim in this study was to examine the change in serum Allopregnanolone levels in patients with ischemic stroke who underwent mechanical thrombectomy. Methods: Patients diagnosed with ischemic stroke and underwent mechanical thrombectomy in Samsun Training and Research Hospital Emergency Service between December 2020 and February 2021 were included in the study. Serum Allopregnanolone levels from blood samples were measured by Enzyme-Linked Immuno Sorbent Assay (ELISA) method. Results: Twenty-two stroke patients who underwent mechanical thrombectomy and 20 healthy volunteers were included in the study. The mean serum Allopregnanolone value at 0h was 56,439 (31.71-253.07), and the median serum Allopregnanolone value of the healthy control group was 51.219 (23.43-87.98), and no statistically significant difference was found (p=0.078). No significant difference existed between the patient group's 0th-hour, 12th-hour, and 5th-day Allopregnanolone levels (p=0.554). There was no significant relationship between the serum Allopregnanolone levels at the 0th hour, 12th hour, and 5th day of the patient group and the 3rd-month mRS scores (p=0.713, p=0.616, p=0.867, respectively). Conclusion: Serum Allopregnanolone levels do not help diagnose, treat, and prognosis of patients with acute ischemic stroke who underwent mechanical thrombectomy. A clinical study with more patients should be updated with our findings.

Keywords

• Ischemic stroke
• Mechanical thrombectomy
• Allopregnanolone
• Diagnosis
• Prognosis

Acil Servise Başvuran ve Mekanik Trombektomi Uygulanan Akut İnme Hastalarında Serum Allopregnanolon Düzeylerinin Değerlendirilmesi

Abstract

Amaç: İskemik inme, beynin perfüzyonunun bozulması sonucu oluşan bir hastalıktır ve kardiyovasküler hastalıklardan sonraki ikinci en sık ölüm nedenidir. İnme hastalarına erken tanı koymak ve hastaların prognozlarını öngörmek amacıyla yapılan biyokimyasal belirteç çalışmaları araştırmacıların ilgi odağı olmuştur. Bu çalışmadaki primer amacımız mekanik trombektomi uygulanan iskemik inme hastalarındaki serum Allopregnanolon düzeylerindeki değişimi incelemektir. Yöntem: Çalışma Aralık 2020 ile Şubat 2021 tarihleri arasında Samsun Eğitim ve Araştırma Hastanesi Acil Servisinde iskemik inme tanısı almış ve mekanik trombektomi yapılan hastalar dahil edildi. Alınan kan örneklerinden serum Allopregnanolon düzeyleri Enzyme-Linked Immuno Sorbent Assay (ELISA) yöntemiyle ölçüldü. Bulgular: Çalışmaya mekanik trombektomi yapılan 22 inme hastası ve kontrol grubunu oluşturan 20 sağlıklı gönüllü dahil edildi. 0.saat serum Allopregnanolon ortanca değeri 56.439 (31.71-253.07), sağlıklı kontrol grubunun serum Allopregnanolon ortanca değeri 51.219 (23.43-87.98) olup istatistiksel olarak anlamlı fark saptanmamıştır (p=0.078). Hasta grubunun 0.saat, 12.saat ve 5.gün Alloprenanolon düzeyleri arasında anlamlı fark yoktu (p=0.554). Hasta grubunun 0.saatteki, 12.saatteki ve 5.gündeki serum Allopregnanolon düzeyleri ile 3. ay mRS skorları arasında anlamlı ilişki yoktu (p=0.713, p=0.616, p=0.867; sırasıyla). Sonuç: Serum Allopregnanolon düzeyleri, mekanik trombektomi uygulanan akut iskemik inmeli hastaların tanı, tedavi ve prognozuna yardımcı olamaz. Daha fazla sayıda hasta içeren bir klinik çalışma ile bulgularımız güncellenmelidir.

Keywords

• İskemik inme
• Mekanik trombektomi
• Allopregnanolon
• Tanı
• Prognoz

References

1. Johnston SC, Gress DR, Browner WS, Sidney S. Short-term prognosis after emergency department diagnosis of TIA. JAMA. 2000 Dec 13;284(22):2901-6.
2. Sohn CH, “Sohn CH,” in In Acute Ischemic Stroke Medical, Endovascular and Surgical Techniques, Jaechan Park, Ed. Singapore: Springer Nature, 2017, p. 35–59.
3. Jauch EC, Saver JL, Adams HP Jr, Bruno A, Connors JJ, Demaerschalk BM, Khatri P, McMullan PW Jr, Qureshi AI, Rosenfield K, Scott PA, Summers DR, Wang DZ, Wintermark M, Yonas H; American Heart Association Stroke Council; Council on Cardiovascular Nursing; Council on Peripheral Vascular Disease; Council on Clinical Cardiology. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013 Mar;44(3):870-947.
4. Paul SM, Purdy RH. Neuroactive steroids. FASEB J. 1992 Mar;6(6):2311-22. PMID: 1347506.
5. Rupprecht R, Holsboer F. Neuroactive steroids: mechanisms of action and neuropsychopharmacological perspectives. Trends Neurosci. 1999 Sep;22(9):410-6. doi: 10.1016/s0166-2236(99)01399-5. PMID: 10441302.
6. Leichnetz GR. Connections of the medial posterior parietal cortex (area 7m) in the monkey. Anat Rec. 2001 Jun 1;263(2):215- 36.
7. Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, Dávalos A, Majoie CB, van der Lugt A, de Miquel MA, Donnan GA, Roos YB, Bonafe A, Jahan R, Diener HC, van den Berg LA, Levy EI, Berkhemer OA, Pereira VM, Rempel J, Millán M, Davis SM, Roy D, Thornton J, Román LS, Ribó M, Beumer D, Stouch B, Brown S, Campbell BC, van Oostenbrugge RJ, Saver JL, Hill MD, Jovin TG; HERMES collaborators. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomized trials. Lancet. 2016 Apr 23;387(10029):1723-31.
8. Kammersgaard LP, Jørgensen HS, Reith J, Nakayama H, Pedersen PM, Olsen TS; Copenhagen Stroke Study. Short- and long-term prognosis for very old stroke patients. The Copenhagen Stroke Study. Age Ageing. 2004 Mar;33(2):149-54.

9. Steiner T, Mendoza G, De Georgia M, Schellinger P, Holle R, Hacke W. Prognosis of stroke patients requiring mechanical ventilation in a neurological critical care unit. Stroke. 1997 Apr;28(4):711-5.
10. Kocatürk Ö, Kocatürk M. Endovasküler Akut İskemik İnme Tedavisi: İlk 100 Vakanın Analizi. Harran Üniversitesi Tıp Fakültesi Dergisi. 2021; 18(1): 82-87.
11. Ünal B, Ergör G, Horasan G, Kalaça S, Sözmen K. Türkiye Kronik Hastalıklar ve Risk Faktörleri Sıklığı Çalışması. Ankara: Sağlık Bakanlığı; 2013, p.52
12. Sulter G, Steen C, De Keyser J. Use of the Barthel index and modified Rankin scale in acute stroke trials. Stroke. 1999 Aug;30(8):1538- 41. doi: 10.1161/01.str.30.8.1538. PMID: 10436097