Acil Serviste İskemik Uyanma İnmesi Hastalarında Serum Subfatin Düzeyleri ve Klinik Sonuçlar Arasındaki İlişkinin Araştırılması

Öz

Bu çalışmanın amacı, acil serviste iskemik uyanma inmesi tanısı alan hastalarda başvuru anında ölçülen serum subfatin düzeylerinin, 28 ve 90. gün mortalite ve fonksiyonel sonuçlar (Modified Rankin Scale, mRS) ile ilişkisini araştırmaktır. Nisan 2022-Mart 2023 tarihleri arasında acil servise uyanma inmesi ile başvuran 66 hasta ve 71 sağlıklı kontrol prospektif olarak değerlendirildi. Tüm katılımcılardan alınan serum örneklerinde subfatin düzeyleri ELISA yöntemiyle ölçüldü. Hastaların 28 ve 90. gün mortalite ve mRS skorları kaydedildi. Hasta grubunda serum subfatin düzeyleri anlamlı olarak daha düşük bulundu (medyan: 1,44 ng/dL; kontrol: 1,65 ng/dL; p<0,001). Ancak, subfatin düzeyleri ile 28 ve 90. gün mortalite veya 90. gün mRS skorları arasında anlamlı bir ilişki saptanmadı (p>0,05). Subfatin düzeyleri, anterior serebral arter ve superior serebellar arter tutulumu olan hastalarda anlamlı farklılık gösterdi (p<0,05). Serum subfatin düzeyleri, iskemik uyanma inmesi hastalarında sağlıklı kontrollere göre daha düşüktür. Ancak, subfatin düzeyleri ile kısa ve orta vadeli mortalite veya fonksiyonel sonuçlar arasında anlamlı bir ilişki bulunmamıştır. Bulguların doğrulanması için daha geniş ölçekli çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• subfatin
• uyanma inmesi
• acil servis
• modifiye Rankin skoru

Investigation of the Relationship Between Serum Subfatin Levels and Clinical Outcomes in Patients with Ischemic Wake-Up Stroke in the Emergency Department

Öz

This study aimed to investigate the association between admission serum subfatin levels and 28- and 90-day mortality and functional outcomes (Modified Rankin Scale, mRS) in patients diagnosed with ischemic wake-up stroke in the emergency department. Between April 2022 and March 2023, 66 patients presenting with wake-up stroke and 71 healthy controls were prospectively evaluated. Serum subfatin levels were measured by ELISA in all participants. Mortality and mRS scores at 28 and 90 days were recorded for the patient group. Serum subfatin levels were significantly lower in the patient group compared to controls (median: 1.44 ng/dL vs. 1.65 ng/dL; p<0.001). However, there was no significant association between subfatin levels and 28- or 90-day mortality or 90-day mRS scores (p>0.05). Subfatin levels showed significant differences in patients with anterior cerebral artery and superior cerebellar artery involvement (p<0.05). Serum subfatin levels are lower in patients with ischemic wake-up stroke than in healthy controls. However, no significant relationship was found between subfatin levels and short- or medium-term mortality or functional outcomes. Larger studies are needed to validate these findings.

Anahtar Kelimeler

• subfatin
• wake - up stroke
• emergency department
• modified Rankin scale

Kaynakça

1. 1. Yuksel M, A. Ö. Uyanma İnmesi In: Kaya H YD, ed. Nörolojik Aciller. İstanbul: Nobel Tıp Kitapevleri; 2023:163-174.
2. 2. Feigin VL, Brainin M, Norrving B, et al. World Stroke Organization (WSO): global stroke fact sheet 2022. International Journal of Stroke. 2022;17(1):18-29.
3. 3. Krishnamurthi RV, Feigin VL, Forouzanfar MH, et al. Global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet Glob Health. 2013;1(5):e259-281.
4. 4. Yoshie T, Ueda T, Takada T, et al. Effects of Pretreatment Cerebral Blood Volume and Time to Recanalization on Clinical Outcomes in Endovascular Thrombectomy for Acute Ischemic Stroke. J Stroke Cerebrovasc Dis. 2018;27(7):1802-1809.
5. 5. Rao RR, Long JZ, White JP, et al. Meteorin-like is a hormone that regulates immune-adipose interactions to increase beige fat thermogenesis. Cell. 2014;157(6):1279-1291.
6. 6. Zheng SL, Li ZY, Song J, Liu JM, Miao CY. Metrnl: a secreted protein with new emerging functions. Acta Pharmacol Sin. 2016;37(5):571-579.
7. 7. Jørgensen JR, Fransson A, Fjord-Larsen L, et al. Cometin is a novel neurotrophic factor that promotes neurite outgrowth and neuroblast migration in vitro and supports survival of spiral ganglion neurons in vivo. Exp Neurol. 2012;233(1):172-181.
8. 8. Li ZY, Zheng SL, Wang P, et al. Subfatin is a novel adipokine and unlike Meteorin in adipose and brain expression. CNS Neurosci Ther. 2014;20(4):344-354.

9. 9. Ushach I, Burkhardt AM, Martinez C, et al. METEORIN-LIKE is a cytokine associated with barrier tissues and alternatively activated macrophages. Clin Immunol. 2015;156(2):119-127.
10. 10. Li Z, Gao Z, Sun T, et al. Meteorin-like/Metrnl, a novel secreted protein implicated in inflammation, immunology, and metabolism: A comprehensive review of preclinical and clinical studies. Front Immunol. 2023;14:1098570.
11. 11. Ng YS, Stein J, Ning M, Black-Schaffer RM. Comparison of clinical characteristics and functional outcomes of ischemic stroke in different vascular territories. Stroke. 2007;38(8):2309-2314.
12. 12. Chung JW, Park SH, Kim N, et al. Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification and vascular territory of ischemic stroke lesions diagnosed by diffusion-weighted imaging. J Am Heart Assoc. 2014;3(4).
13. 13. Yüksel M, Kaya H, Ay MO, et al. A prospective study of wake-up stroke patients presenting to the emergency department: a single-center cohort study. Ir J Med Sci. 2023;192(1):409-416.
14. 14. Nogueira RG, Jadhav AP, Haussen DC, et al. Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct. N Engl J Med. 2018;378(1):11-21.
15. 15. Albers GW, Marks MP, Kemp S, et al. Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging. N Engl J Med. 2018;378(8):708-718.
16. 16. Thomalla G, Simonsen CZ, Boutitie F, et al. MRI-Guided Thrombolysis for Stroke with Unknown Time of Onset. N Engl J Med. 2018;379(7):611-622.
17. 17. Yilmaz M, Cagri Goktekin M, Ilhan N. Subfatin concentration decreases in acute coronary syndrome. Biochem Med (Zagreb). 2022;32(2):020704.
18. 18. Albayrak S, Aydin MA, Ugur K, et al. Subfatin, asprosin, alamandine and maresin-1 in cerebral ischemia, intracranial and subarachnoid hemorrhages. Eur Rev Med Pharmacol Sci. 2023;27(10):4471-4480.
19. 19. Dadmanesh M, Aghajani H, Fadaei R, Ghorban K. Lower serum levels of Meteorin-like/Subfatin in patients with coronary artery disease and type 2 diabetes mellitus are negatively associated with insulin resistance and inflammatory cytokines. PLoS One. 2018;13(9):e0204180.
20. 20. Demir HA, Seyhanli ES, Demir TG, Koyuncu I. Subfatin levels and thiol balance in patients with stroke. Neurology Asia. 2023;28(2).