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Akut iskemik inmede serum iskemiye modifiye albümin düzeyleri ile prognoz arasındaki ilişki

Year 2025, Volume: 16 Issue: 3, 600 - 609, 30.09.2025
https://doi.org/10.18663/tjcl.1761242

Abstract

Amaç: Bu çalışmada, acil serviste akut iskemik inme (AİS) tanısı alan erişkin hastalarda serum iskemiye modifiye albümin (İMA) düzeyleri ile inme şiddeti ve fonksiyonel sonuçlar arasındaki ilişkinin araştırılması amaçlandı.
Gereç ve Yöntem: Prospektif gözlemsel tasarımla yürütülen çalışmaya, 40 AİS hastası ve yaş-cinsiyet açısından eşleştirilmiş 20 sağlıklı kontrol alındı. Serum İMA düzeyleri başvuru anında ticari ELISA kiti ile ölçüldü. İnme şiddeti Ulusal Sağlık Enstitüleri İnme Ölçeği (NIHSS) ile değerlendirildi. Üçüncü ay fonksiyonel sonuçları, modifiye Rankin Skalası (mRS) ile belirlendi ve mRS ≥2 kötü fonksiyonel sonuç (KFS) olarak tanımlandı.
Bulgular: Medyan İMA düzeyleri AİS grubunda kontrol grubuna göre anlamlı derecede yüksekti. Yüksek İMA düzeyleri, AİS (düzeltilmiş OR: 1,18; %95 GA: 1,03–1,35; p = 0,015), şiddetli inme (düzeltilmiş OR: 1,38; %95 GA: 1,06–1,83; p = 0,018) ve 3. ayda KFS (düzeltilmiş OR: 1,16; %95 GA: 1,04–1,30; p = 0,008) ile bağımsız olarak ilişkiliydi. ROC analizi, AİS için >58 ng/mL (EAA: 0,859), şiddetli inme için >76,7 ng/mL (EAA: 0,890) ve KFS için >65,4 ng/mL (EAA: 0,854) eşik değerlerini belirledi.
Sonuçlar: Serum İMA düzeyleri, AİS hastalarında artmakta ve hem başlangıç inme şiddeti hem de uzun dönem fonksiyonel sonuçlarla ilişkili bulunmaktadır. İMA, AİS’te erken risk sınıflaması için hızlı ve düşük maliyetli bir biyobelirteç olarak kullanılma potansiyeline sahiptir.

References

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  • Feigin VL, Brainin M, Norrving B, et al. World Stroke Organization: Global Stroke Fact Sheet 2025. Int J Stroke. 2025;20(2):132-44. DOI: 10.1177/17474930241308142.
  • Qin C, Yang S, Chu YH, et al. Signaling pathways involved in ischemic stroke: molecular mechanisms and therapeutic interventions. Signal Transduct Target Ther. 2022;7(1):215. DOI: 10.1038/s41392-022-01064-1.
  • Salaudeen MA, Bello N, Danraka RN, and Ammani ML. Understanding the Pathophysiology of Ischemic Stroke: The Basis of Current Therapies and Opportunity for New Ones. Biomolecules. 2024;14(3) DOI: 10.3390/biom14030305.
  • Kong J, Fan R, Zhang Y, et al. Oxidative stress in the brain-lung crosstalk: cellular and molecular perspectives. Front Aging Neurosci. 2024;16:1389454. DOI: 10.3389/fnagi.2024.1389454.
  • Elsayed WM, Abdel-Gawad E-HA, Mesallam DI, and El-Serafy TS. The relationship between oxidative stress and acute ischemic stroke severity and functional outcome. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery. 2020;56(1):74.
  • Kamal FZ, Lefter R, Jaber H, Balmus IM, Ciobica A, and Iordache AC. The Role of Potential Oxidative Biomarkers in the Prognosis of Acute Ischemic Stroke and the Exploration of Antioxidants as Possible Preventive and Treatment Options. Int J Mol Sci. 2023;24(7) DOI: 10.3390/ijms24076389.
  • Maas MB and Furie KL. Molecular biomarkers in stroke diagnosis and prognosis. Biomark Med. 2009;3(4):363-83. DOI: 10.2217/bmm.09.30.
  • Coverdale JPC, Katundu KGH, Sobczak AIS, Arya S, Blindauer CA, and Stewart AJ. Ischemia-modified albumin: Crosstalk between fatty acid and cobalt binding. Prostaglandins Leukot Essent Fatty Acids. 2018;135:147-57. DOI: 10.1016/j.plefa.2018.07.014.
  • Bal W, Sokolowska M, Kurowska E, and Faller P. Binding of transition metal ions to albumin: sites, affinities and rates. Biochim Biophys Acta. 2013;1830(12):5444-55. DOI: 10.1016/j.bbagen.2013.06.018.
  • Watanabe H, Imafuku T, Otagiri M, and Maruyama T. Clinical Implications Associated With the Posttranslational Modification-Induced Functional Impairment of Albumin in Oxidative Stress-Related Diseases. J Pharm Sci. 2017;106(9):2195-203. DOI: 10.1016/j.xphs.2017.03.002.
  • Yeniocak S, Sarac F, Yazicioglu M, et al. The Diagnostic Values of Ischemia-Modified Albumin in Patients with Acute Abdominal Pain and Its Role in Differentiating Acute Abdomen. Emerg Med Int. 2020;2020:7925975. DOI: 10.1155/2020/7925975.
  • Shevtsova A, Gordiienko I, Tkachenko V, and Ushakova G. Ischemia-Modified Albumin: Origins and Clinical Implications. Dis Markers. 2021;2021:9945424. DOI: 10.1155/2021/9945424.
  • Chen T, Cui Y, and Chen HS. The association of gender with functional outcome in thrombolysed stroke: A secondary analysis of INTRECIS study. Heliyon. 2024;10(11):e32630. DOI: 10.1016/j.heliyon.2024.e32630.
  • Weisscher N, Vermeulen M, Roos YB, and de Haan RJ. What should be defined as good outcome in stroke trials; a modified Rankin score of 0-1 or 0-2? J Neurol. 2008;255(6):867-74. DOI: 10.1007/s00415-008-0796-8.
  • Mangoni AA and Zinellu A. A Systematic Review and Meta-Analysis of Serum Concentrations of Ischaemia-Modified Albumin in Acute Ischaemic Stroke, Intracerebral Haemorrhage, and Subarachnoid Haemorrhage. Biomolecules. 2022;12(5) DOI: 10.3390/biom12050653.
  • Shi W, Tang G, Zhou X, and Ye Y. Appraising the Accuracy of Ischaemia-Modified Albumin in Diagnosing Stroke: A Systematic Review and Meta-Analysis. Cerebrovasc Dis. 2021;50(4):365-70. DOI: 10.1159/000514382.
  • Menon B, Ramalingam K, and Krishna V. Study of Ischemia Modified Albumin as a Biomarker in Acute Ischaemic Stroke. Ann Neurosci. 2018;25(4):187-90. DOI: 10.1159/000488188.
  • Soliman HS, Okda MA, El-Kholy MS, and El-Kabany RA. Ischemia-modified albumin for evaluating severity and predicting prognosis in patients with acute cerebrovascular disease. Menoufia Medical Journal. 2020;33(3):1072-76.
  • Gunduz A, Turedi S, Mentese A, et al. Ischemia-modified albumin levels in cerebrovascular accidents. Am J Emerg Med. 2008;26(8):874-8. DOI: 10.1016/j.ajem.2007.11.023.
  • Ertekin B, Kocak S, Defne Dundar Z, et al. Diagnostic value of ischemia-modified albumin in acute coronary syndrome and acute ischemic stroke. Pak J Med Sci. 2013;29(4):1003-7.
  • Çakmak VA, Gündüz A, Karaca Y, Alioğlu Z, Menteşe A, and Topbaş M. Diagnostic Significance of Ischemia-Modified Albumin, S100b, and Neuron-Specific Enolase in Acute Ischemic Stroke. Journal of Academic Emergency Medicine/Akademik Acil Tip Olgu Sunumlari Dergisi. 2014;13(3).
  • Elshony HS, Okda MA, and El-Kabany RA. Ischemia-modified albumin and fibulin-5 as diagnostic and prognostic markers for acute cerebrovascular disease. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery. 2021;57(1):12.
  • Can S, Akdur O, Yildirim A, Adam G, Cakir DU, and Karaman HI. Myelin basic protein and ischemia modified albumin levels in acute ischemic stroke cases. Pak J Med Sci. 2015;31(5):1110-4. DOI: 10.12669/pjms.315.7702.
  • Demirci B, Karakılıç ME, Coşkun A, et al. The brain ischemic volume correlation with the ischemic modified albumin level. Bagcilar Medical Bulletin. 2021.
  • Ahn JH, Choi SC, Lee WG, and Jung YS. The usefulness of albumin-adjusted ischemia-modified albumin index as early detecting marker for ischemic stroke. Neurol Sci. 2011;32(1):133-8. DOI: 10.1007/s10072-010-0457-4.
  • Nayak AR, Kashyap RS, Kabra D, Purohit HJ, Taori GM, and Daginawala HF. Prognostic significance of ischemia-modified albumin in acute ischemic stroke patients: A preliminary study. Ann Neurosci. 2011;18(1):5-7. DOI: 10.5214/ans.0972.7531.1118103.
  • Roy D, Quiles J, Gaze DC, Collinson P, Kaski JC, and Baxter GF. Role of reactive oxygen species on the formation of the novel diagnostic marker ischaemia modified albumin. Heart. 2006;92(1):113-4. DOI: 10.1136/hrt.2004.049643.
  • Lee P and Wu X. Review: modifications of human serum albumin and their binding effect. Curr Pharm Des. 2015;21(14):1862-5. DOI: 10.2174/1381612821666150302115025.
  • Jena I, Nayak SR, Behera S, et al. Evaluation of ischemia-modified albumin, oxidative stress, and antioxidant status in acute ischemic stroke patients. J Nat Sci Biol Med. 2017;8(1):110-13. DOI: 10.4103/0976-9668.198346.

The relationship between serum ischemia-modified albumin levels and prognosis in acute ischemic stroke

Year 2025, Volume: 16 Issue: 3, 600 - 609, 30.09.2025
https://doi.org/10.18663/tjcl.1761242

Abstract

Aim: This study aimed to investigate the association between serum ischemia-modified albumin (IMA) levels, stroke severity, and functional outcomes in adult patients diagnosed with acute ischemic stroke (AIS) in the emergency department.
Material and Methods: In this prospective observational study, 40 AIS patients and 20 age- and sex-matched healthy controls were enrolled. Serum IMA levels were measured at admission using a commercial ELISA kit. Stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS), and functional outcomes at 3 months were determined using the modified Rankin Scale (mRS), with scores ≥2 defined as poor functional outcome (PFO).
Results: Median IMA levels were significantly higher in AIS patients than controls. Elevated IMA was independently associated with AIS (adjusted OR: 1.18, 95% CI: 1.03–1.35, p = 0.015), severe stroke (adjusted OR: 1.38, 95% CI: 1.06–1.83, p = 0.018), and PFO at 3 months (adjusted OR: 1.16, 95% CI: 1.04–1.30, p = 0.008). ROC analysis identified IMA cutoffs of >58 ng/mL for AIS (AUC: 0.859), >76.7 ng/mL for severe stroke (AUC: 0.890), and >65.4 ng/mL for PFO (AUC: 0.854).
Conclusion: Serum IMA levels are elevated in AIS and correlate with both initial stroke severity and short-term functional outcomes. IMA may serve as a rapid, cost-effective biomarker for early risk stratification in AIS.

Ethical Statement

The study was performed in accordance with the Declaration of Helsinki, and was approved by Bursa Uludağ University Clinical Research Ethics Committee (Date: 16.05.2023, Decision No: 2023-11/21).

References

  • Kuriakose D and Xiao Z. Pathophysiology and Treatment of Stroke: Present Status and Future Perspectives. Int J Mol Sci. 2020;21(20) DOI: 10.3390/ijms21207609.
  • Feigin VL, Brainin M, Norrving B, et al. World Stroke Organization: Global Stroke Fact Sheet 2025. Int J Stroke. 2025;20(2):132-44. DOI: 10.1177/17474930241308142.
  • Qin C, Yang S, Chu YH, et al. Signaling pathways involved in ischemic stroke: molecular mechanisms and therapeutic interventions. Signal Transduct Target Ther. 2022;7(1):215. DOI: 10.1038/s41392-022-01064-1.
  • Salaudeen MA, Bello N, Danraka RN, and Ammani ML. Understanding the Pathophysiology of Ischemic Stroke: The Basis of Current Therapies and Opportunity for New Ones. Biomolecules. 2024;14(3) DOI: 10.3390/biom14030305.
  • Kong J, Fan R, Zhang Y, et al. Oxidative stress in the brain-lung crosstalk: cellular and molecular perspectives. Front Aging Neurosci. 2024;16:1389454. DOI: 10.3389/fnagi.2024.1389454.
  • Elsayed WM, Abdel-Gawad E-HA, Mesallam DI, and El-Serafy TS. The relationship between oxidative stress and acute ischemic stroke severity and functional outcome. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery. 2020;56(1):74.
  • Kamal FZ, Lefter R, Jaber H, Balmus IM, Ciobica A, and Iordache AC. The Role of Potential Oxidative Biomarkers in the Prognosis of Acute Ischemic Stroke and the Exploration of Antioxidants as Possible Preventive and Treatment Options. Int J Mol Sci. 2023;24(7) DOI: 10.3390/ijms24076389.
  • Maas MB and Furie KL. Molecular biomarkers in stroke diagnosis and prognosis. Biomark Med. 2009;3(4):363-83. DOI: 10.2217/bmm.09.30.
  • Coverdale JPC, Katundu KGH, Sobczak AIS, Arya S, Blindauer CA, and Stewart AJ. Ischemia-modified albumin: Crosstalk between fatty acid and cobalt binding. Prostaglandins Leukot Essent Fatty Acids. 2018;135:147-57. DOI: 10.1016/j.plefa.2018.07.014.
  • Bal W, Sokolowska M, Kurowska E, and Faller P. Binding of transition metal ions to albumin: sites, affinities and rates. Biochim Biophys Acta. 2013;1830(12):5444-55. DOI: 10.1016/j.bbagen.2013.06.018.
  • Watanabe H, Imafuku T, Otagiri M, and Maruyama T. Clinical Implications Associated With the Posttranslational Modification-Induced Functional Impairment of Albumin in Oxidative Stress-Related Diseases. J Pharm Sci. 2017;106(9):2195-203. DOI: 10.1016/j.xphs.2017.03.002.
  • Yeniocak S, Sarac F, Yazicioglu M, et al. The Diagnostic Values of Ischemia-Modified Albumin in Patients with Acute Abdominal Pain and Its Role in Differentiating Acute Abdomen. Emerg Med Int. 2020;2020:7925975. DOI: 10.1155/2020/7925975.
  • Shevtsova A, Gordiienko I, Tkachenko V, and Ushakova G. Ischemia-Modified Albumin: Origins and Clinical Implications. Dis Markers. 2021;2021:9945424. DOI: 10.1155/2021/9945424.
  • Chen T, Cui Y, and Chen HS. The association of gender with functional outcome in thrombolysed stroke: A secondary analysis of INTRECIS study. Heliyon. 2024;10(11):e32630. DOI: 10.1016/j.heliyon.2024.e32630.
  • Weisscher N, Vermeulen M, Roos YB, and de Haan RJ. What should be defined as good outcome in stroke trials; a modified Rankin score of 0-1 or 0-2? J Neurol. 2008;255(6):867-74. DOI: 10.1007/s00415-008-0796-8.
  • Mangoni AA and Zinellu A. A Systematic Review and Meta-Analysis of Serum Concentrations of Ischaemia-Modified Albumin in Acute Ischaemic Stroke, Intracerebral Haemorrhage, and Subarachnoid Haemorrhage. Biomolecules. 2022;12(5) DOI: 10.3390/biom12050653.
  • Shi W, Tang G, Zhou X, and Ye Y. Appraising the Accuracy of Ischaemia-Modified Albumin in Diagnosing Stroke: A Systematic Review and Meta-Analysis. Cerebrovasc Dis. 2021;50(4):365-70. DOI: 10.1159/000514382.
  • Menon B, Ramalingam K, and Krishna V. Study of Ischemia Modified Albumin as a Biomarker in Acute Ischaemic Stroke. Ann Neurosci. 2018;25(4):187-90. DOI: 10.1159/000488188.
  • Soliman HS, Okda MA, El-Kholy MS, and El-Kabany RA. Ischemia-modified albumin for evaluating severity and predicting prognosis in patients with acute cerebrovascular disease. Menoufia Medical Journal. 2020;33(3):1072-76.
  • Gunduz A, Turedi S, Mentese A, et al. Ischemia-modified albumin levels in cerebrovascular accidents. Am J Emerg Med. 2008;26(8):874-8. DOI: 10.1016/j.ajem.2007.11.023.
  • Ertekin B, Kocak S, Defne Dundar Z, et al. Diagnostic value of ischemia-modified albumin in acute coronary syndrome and acute ischemic stroke. Pak J Med Sci. 2013;29(4):1003-7.
  • Çakmak VA, Gündüz A, Karaca Y, Alioğlu Z, Menteşe A, and Topbaş M. Diagnostic Significance of Ischemia-Modified Albumin, S100b, and Neuron-Specific Enolase in Acute Ischemic Stroke. Journal of Academic Emergency Medicine/Akademik Acil Tip Olgu Sunumlari Dergisi. 2014;13(3).
  • Elshony HS, Okda MA, and El-Kabany RA. Ischemia-modified albumin and fibulin-5 as diagnostic and prognostic markers for acute cerebrovascular disease. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery. 2021;57(1):12.
  • Can S, Akdur O, Yildirim A, Adam G, Cakir DU, and Karaman HI. Myelin basic protein and ischemia modified albumin levels in acute ischemic stroke cases. Pak J Med Sci. 2015;31(5):1110-4. DOI: 10.12669/pjms.315.7702.
  • Demirci B, Karakılıç ME, Coşkun A, et al. The brain ischemic volume correlation with the ischemic modified albumin level. Bagcilar Medical Bulletin. 2021.
  • Ahn JH, Choi SC, Lee WG, and Jung YS. The usefulness of albumin-adjusted ischemia-modified albumin index as early detecting marker for ischemic stroke. Neurol Sci. 2011;32(1):133-8. DOI: 10.1007/s10072-010-0457-4.
  • Nayak AR, Kashyap RS, Kabra D, Purohit HJ, Taori GM, and Daginawala HF. Prognostic significance of ischemia-modified albumin in acute ischemic stroke patients: A preliminary study. Ann Neurosci. 2011;18(1):5-7. DOI: 10.5214/ans.0972.7531.1118103.
  • Roy D, Quiles J, Gaze DC, Collinson P, Kaski JC, and Baxter GF. Role of reactive oxygen species on the formation of the novel diagnostic marker ischaemia modified albumin. Heart. 2006;92(1):113-4. DOI: 10.1136/hrt.2004.049643.
  • Lee P and Wu X. Review: modifications of human serum albumin and their binding effect. Curr Pharm Des. 2015;21(14):1862-5. DOI: 10.2174/1381612821666150302115025.
  • Jena I, Nayak SR, Behera S, et al. Evaluation of ischemia-modified albumin, oxidative stress, and antioxidant status in acute ischemic stroke patients. J Nat Sci Biol Med. 2017;8(1):110-13. DOI: 10.4103/0976-9668.198346.
There are 30 citations in total.

Details

Primary Language English
Subjects Emergency Medicine, Neurology and Neuromuscular Diseases
Journal Section Research Article
Authors

Göksel Aydoğan 0009-0006-2750-207X

Vahide Aslıhan Durak 0000-0003-0836-7862

Ayşe Armağan Aydoğan 0009-0002-0534-3654

Yasemin Dinç 0000-0003-0342-5939

Beliz Akçakoca 0000-0002-1393-5847

Arzu Yılmaztepe Oral 0000-0002-8962-9758

Publication Date September 30, 2025
Submission Date August 8, 2025
Acceptance Date September 28, 2025
Published in Issue Year 2025 Volume: 16 Issue: 3

Cite

APA Aydoğan, G., Durak, V. A., Aydoğan, A. A., … Dinç, Y. (2025). The relationship between serum ischemia-modified albumin levels and prognosis in acute ischemic stroke. Turkish Journal of Clinics and Laboratory, 16(3), 600-609. https://doi.org/10.18663/tjcl.1761242
AMA Aydoğan G, Durak VA, Aydoğan AA, Dinç Y, Akçakoca B, Yılmaztepe Oral A. The relationship between serum ischemia-modified albumin levels and prognosis in acute ischemic stroke. TJCL. September 2025;16(3):600-609. doi:10.18663/tjcl.1761242
Chicago Aydoğan, Göksel, Vahide Aslıhan Durak, Ayşe Armağan Aydoğan, Yasemin Dinç, Beliz Akçakoca, and Arzu Yılmaztepe Oral. “The Relationship Between Serum Ischemia-Modified Albumin Levels and Prognosis in Acute Ischemic Stroke”. Turkish Journal of Clinics and Laboratory 16, no. 3 (September 2025): 600-609. https://doi.org/10.18663/tjcl.1761242.
EndNote Aydoğan G, Durak VA, Aydoğan AA, Dinç Y, Akçakoca B, Yılmaztepe Oral A (September 1, 2025) The relationship between serum ischemia-modified albumin levels and prognosis in acute ischemic stroke. Turkish Journal of Clinics and Laboratory 16 3 600–609.
IEEE G. Aydoğan, V. A. Durak, A. A. Aydoğan, Y. Dinç, B. Akçakoca, and A. Yılmaztepe Oral, “The relationship between serum ischemia-modified albumin levels and prognosis in acute ischemic stroke”, TJCL, vol. 16, no. 3, pp. 600–609, 2025, doi: 10.18663/tjcl.1761242.
ISNAD Aydoğan, Göksel et al. “The Relationship Between Serum Ischemia-Modified Albumin Levels and Prognosis in Acute Ischemic Stroke”. Turkish Journal of Clinics and Laboratory 16/3 (September2025), 600-609. https://doi.org/10.18663/tjcl.1761242.
JAMA Aydoğan G, Durak VA, Aydoğan AA, Dinç Y, Akçakoca B, Yılmaztepe Oral A. The relationship between serum ischemia-modified albumin levels and prognosis in acute ischemic stroke. TJCL. 2025;16:600–609.
MLA Aydoğan, Göksel et al. “The Relationship Between Serum Ischemia-Modified Albumin Levels and Prognosis in Acute Ischemic Stroke”. Turkish Journal of Clinics and Laboratory, vol. 16, no. 3, 2025, pp. 600-9, doi:10.18663/tjcl.1761242.
Vancouver Aydoğan G, Durak VA, Aydoğan AA, Dinç Y, Akçakoca B, Yılmaztepe Oral A. The relationship between serum ischemia-modified albumin levels and prognosis in acute ischemic stroke. TJCL. 2025;16(3):600-9.