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Neurology International
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Biomarkers in Stroke Prognosis
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Biomarkers in Stroke Prognosis

A topical collection in Neurology International (ISSN 2035-8377).

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Editors

Dr. Dimitrios Tsiptsios

E-Mail Website
Guest Editor
3rd Department of Neurology, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
Interests: epilepsy; clinical neurophysiology; stroke; neuromuscular disorders
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Konstantinos Vadikolias

E-Mail Website
Guest Editor
Neurology Department, Democritus University of Thrace, Alexandroupolis, Greece
Interests: stroke; neuroimaging

Topical Collection Information

Dear Colleagues,

Stroke represents not only the second leading cause of death, but also the principal source of acquired disability, with considerable negative long-term impacts on functional independence and quality of life for stroke survivors. Prognostic uncertainties are common, resulting in a growing interest in establishing stroke recovery biomarkers. Ideally, prognostic biomarkers should hold high sensitivity and specificity, enabling the appropriate management of health-care resources and individualization of rehabilitation treatments. Given the complexity and heterogeneity of stroke pathophysiology, it is obvious that a single biomarker cannot give us all the answers we seek.

This Special Issue aims to cover the newest advancements in the field of stroke recovery biomarkers, and invites authors to contribute original studies, reviews, meta-analyses, and related case reports regarding blood, neuroimaging, neurosonological, neurophysiological, and biomechanical biomarkers that depict underlying mechanisms of disease, provide insight into pathogenesis of functional deficits in stroke survivors, as well as compensatory mechanisms on a microstructural level, assess corticospinal tract integrity and brain connectivity and characterize post-stroke recovery mechanisms for various deficits including motor, language, and cognition. Studies utilizing machine learning and other types of advanced data analytics techniques attempting to construct stroke prognosis algorithms are also welcomed.

Dr. Dimitrios Tsiptsios
Prof. Dr. Konstantinos Vadikolias
Guest Editors

Manuscript Submission Information

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Keywords

  • stroke prognosis
  • stroke recovery
  • prognostic models
  • blood biomarkers
  • neuroimaging
  • advanced computational neuroimaging analyses
  • neurophysiology
  • neurosonology
  • gait analyses
  • machine learning

Published Papers (7 papers)

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2024

Jump to: 2023, 2022

15 pages, 3171 KiB  
Article
Introducing the Futile Recanalization Prediction Score (FRPS): A Novel Approach to Predict and Mitigate Ineffective Recanalization after Endovascular Treatment of Acute Ischemic Stroke
by Helen Shen, Bella B. Huasen, Murray C. Killingsworth and Sonu M. M. Bhaskar
Neurol. Int. 2024, 16(3), 605-619; https://doi.org/10.3390/neurolint16030045 - 30 May 2024
Cited by 4 | Viewed by 1277
Abstract
Objective: This study aims to develop and validate the Futile Recanalization Prediction Score (FRPS), a novel tool designed to predict the severity risk of FR and aid in pre- and post-EVT risk assessments. Methods: The FRPS was developed using a rigorous [...] Read more.
Objective: This study aims to develop and validate the Futile Recanalization Prediction Score (FRPS), a novel tool designed to predict the severity risk of FR and aid in pre- and post-EVT risk assessments. Methods: The FRPS was developed using a rigorous process involving the selection of predictor variables based on clinical relevance and potential impact. Initial equations were derived from previous meta-analyses and refined using various statistical techniques. We employed machine learning algorithms, specifically random forest regression, to capture nonlinear relationships and enhance model performance. Cross-validation with five folds was used to assess generalizability and model fit. Results: The final FRPS model included variables such as age, sex, atrial fibrillation (AF), hypertension (HTN), diabetes mellitus (DM), hyperlipidemia, cognitive impairment, pre-stroke modified Rankin Scale (mRS), systolic blood pressure (SBP), onset-to-puncture time, sICH, and NIHSS score. The random forest model achieved a mean R-squared value of approximately 0.992. Severity ranges for FRPS scores were defined as mild (FRPS < 66), moderate (FRPS 66–80), and severe (FRPS > 80). Conclusions: The FRPS provides valuable insights for treatment planning and patient management by predicting the severity risk of FR. This tool may improve the identification of candidates most likely to benefit from EVT and enhance prognostic accuracy post-EVT. Further clinical validation in diverse settings is warranted to assess its effectiveness and reliability. Full article
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2023

Jump to: 2024, 2022

17 pages, 833 KiB  
Systematic Review
Monocyte to HDL and Neutrophil to HDL Ratios as Potential Ischemic Stroke Prognostic Biomarkers
by Aimilios Gkantzios, Dimitrios Tsiptsios, Vaia Karapepera, Stella Karatzetzou, Stratis Kiamelidis, Pinelopi Vlotinou, Erasmia Giannakou, Evangeli Karampina, Katerina Paschalidou, Nikolaos Kourkoutsakis, Nikolaos Papanas, Nikolaos Aggelousis and Konstantinos Vadikolias
Neurol. Int. 2023, 15(1), 301-317; https://doi.org/10.3390/neurolint15010019 - 20 Feb 2023
Cited by 11 | Viewed by 3012
Abstract
Ischemic stroke (IS) exhibits significant heterogeneity in terms of etiology and pathophysiology. Several recent studies highlight the significance of inflammation in the onset and progression of IS. White blood cell subtypes, such as neutrophils and monocytes, participate in the inflammatory response in various [...] Read more.
Ischemic stroke (IS) exhibits significant heterogeneity in terms of etiology and pathophysiology. Several recent studies highlight the significance of inflammation in the onset and progression of IS. White blood cell subtypes, such as neutrophils and monocytes, participate in the inflammatory response in various ways. On the other hand, high-density lipoproteins (HDL) exhibit substantial anti-inflammatory and antioxidant actions. Consequently, novel inflammatory blood biomarkers have emerged, such as neutrophil to HDL ratio (NHR) and monocyte to HDL ratio (MHR). Literature research of two databases (MEDLINE and Scopus) was conducted to identify all relevant studies published between 1 January 2012 and 30 November 2022 dealing with NHR and MHR as biomarkers for IS prognosis. Only full-text articles published in the English language were included. Thirteen articles have been traced and are included in the present review. Our findings highlight the utility of NHR and MHR as novel stroke prognostic biomarkers, the widespread application, and the calculation of which, along with their inexpensive cost, make their clinical application extremely promising. Full article
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35 pages, 1045 KiB  
Systematic Review
Leukoaraiosis as a Predictor of Depression and Cognitive Impairment among Stroke Survivors: A Systematic Review
by Eftychia Tziaka, Foteini Christidi, Dimitrios Tsiptsios, Anastasia Sousanidou, Stella Karatzetzou, Anna Tsiakiri, Triantafyllos K. Doskas, Konstantinos Tsamakis, Nikolaos Retzepis, Christos Konstantinidis, Christos Kokkotis, Aspasia Serdari, Nikolaos Aggelousis and Konstantinos Vadikolias
Neurol. Int. 2023, 15(1), 238-272; https://doi.org/10.3390/neurolint15010016 - 13 Feb 2023
Cited by 8 | Viewed by 3126
Abstract
Stroke survivors are at increased risk of developing depression and cognitive decline. Thus, it is crucial for both clinicians and stroke survivors to be provided with timely and accurate prognostication of post-stroke depression (PSD) and post-stroke dementia (PSDem). Several biomarkers regarding stroke patients’ [...] Read more.
Stroke survivors are at increased risk of developing depression and cognitive decline. Thus, it is crucial for both clinicians and stroke survivors to be provided with timely and accurate prognostication of post-stroke depression (PSD) and post-stroke dementia (PSDem). Several biomarkers regarding stroke patients’ propensity to develop PSD and PSDem have been implemented so far, leukoaraiosis (LA) being among them. The purpose of the present study was to review all available work published within the last decade dealing with pre-existing LA as a predictor of depression (PSD) and cognitive dysfunction (cognitive impairment or PSDem) in stroke patients. A literature search of two databases (MEDLINE and Scopus) was conducted to identify all relevant studies published between 1 January 2012 and 25 June 2022 that dealt with the clinical utility of preexisting LA as a prognostic indicator of PSD and PSDem/cognitive impairment. Only full-text articles published in the English language were included. Thirty-four articles were traced and are included in the present review. LA burden, serving as a surrogate marker of “brain frailty” among stroke patients, appears to be able to offer significant information about the possibility of developing PSD or cognitive dysfunction. Determining the extent of pre-existing white matter abnormalities can properly guide decision making in acute stroke settings, as a greater degree of such lesioning is usually coupled with neuropsychiatric aftermaths, such as PSD and PSDem. Full article
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13 pages, 602 KiB  
Article
Prediction of Poor Outcome after Successful Thrombectomy in Patients with Severe Acute Ischemic Stroke: A Pilot Retrospective Study
by Burak B. Ozkara, Mert Karabacak, Apoorva Kotha, Alperen Aslan, Omar Hamam, Namratha Edpuganti, Meisam Hoseinyazdi, Richard Wang, Brian C. Cristiano and Vivek S. Yedavalli
Neurol. Int. 2023, 15(1), 225-237; https://doi.org/10.3390/neurolint15010015 - 3 Feb 2023
Cited by 3 | Viewed by 2794
Abstract
Several baseline hematologic and metabolic laboratory parameters have been linked to acute ischemic stroke (AIS) clinical outcomes in patients who successfully recanalized. However, no study has directly investigated these relationships within the severe stroke subgroup. The goal of this study is to identify [...] Read more.
Several baseline hematologic and metabolic laboratory parameters have been linked to acute ischemic stroke (AIS) clinical outcomes in patients who successfully recanalized. However, no study has directly investigated these relationships within the severe stroke subgroup. The goal of this study is to identify potential predictive clinical, lab, and radiographic biomarkers in patients who present with severe AIS due to large vessel occlusion and have been successfully treated with mechanical thrombectomy. This single-center, retrospective study included patients who experienced AIS secondary to large vessel occlusion with an initial NIHSS score ≥ 21 and were recanalized successfully with mechanical thrombectomy. Retrospectively, demographic, clinical, and radiologic data from electronic medical records were extracted, and laboratory baseline parameters were obtained from emergency department records. The clinical outcome was defined as the modified Rankin Scale (mRS) score at 90 days, which was dichotomized into favorable functional outcome (mRS 0–3) or unfavorable functional outcome (mRS 4–6). Multivariate logistic regression was used to build predictive models. A total of 53 patients were included. There were 26 patients in the favorable outcome group and 27 in the unfavorable outcome group. Age and platelet count (PC) were found to be predictors of unfavorable outcomes in the multivariate logistic regression analysis. The areas under the receiver operating characteristic (ROC) curve of models 1 (age only model), 2 (PC only model), and 3 (age and PC model) were 0.71, 0.68, and 0.79, respectively. This is the first study to reveal that elevated PC is an independent predictor of unfavorable outcomes in this specialized group. Full article
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37 pages, 642 KiB  
Systematic Review
Exploring the Impact of Cerebral Microbleeds on Stroke Management
by Anastasia Sousanidou, Dimitrios Tsiptsios, Foteini Christidi, Stella Karatzetzou, Christos Kokkotis, Aimilios Gkantzios, Chrisostomos Bairaktaris, Vaia Karapepera, Paschalina Bebeletsi, Ioanna Karagiannakidou, Marinos Marinidis, Nikolaos Aggelousis and Konstantinos Vadikolias
Neurol. Int. 2023, 15(1), 188-224; https://doi.org/10.3390/neurolint15010014 - 1 Feb 2023
Cited by 7 | Viewed by 2912
Abstract
Stroke constitutes a major cause of functional disability and mortality, with increasing prevalence. Thus, the timely and accurate prognosis of stroke outcomes based on clinical or radiological markers is vital for both physicians and stroke survivors. Among radiological markers, cerebral microbleeds (CMBs) constitute [...] Read more.
Stroke constitutes a major cause of functional disability and mortality, with increasing prevalence. Thus, the timely and accurate prognosis of stroke outcomes based on clinical or radiological markers is vital for both physicians and stroke survivors. Among radiological markers, cerebral microbleeds (CMBs) constitute markers of blood leakage from pathologically fragile small vessels. In the present review, we evaluated whether CMBs affect ischemic and hemorrhagic stroke outcomes and explored the fundamental question of whether CMBs may shift the risk–benefit balance away from reperfusion therapy or antithrombotic use in acute ischemic stroke patients. A literature review of two databases (MEDLINE and Scopus) was conducted to identify all the relevant studies published between 1 January 2012 and 9 November 2022. Only full-text articles published in the English language were included. Forty-one articles were traced and included in the present review. Our findings highlight the utility of CMB assessments, not only in the prognostication of hemorrhagic complications of reperfusion therapy, but also in forecasting hemorrhagic and ischemic stroke patients’ functional outcomes, thus indicating that a biomarker-based approach may aid in the provision of counseling for patients and families, improve the selection of more appropriate medical therapies, and contribute to a more accurate choice of patients for reperfusion therapy. Full article
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17 pages, 475 KiB  
Systematic Review
Copeptin Implementation on Stroke Prognosis
by Stella Karatzetzou, Dimitrios Tsiptsios, Anastasia Sousanidou, Styliani Fotiadou, Foteini Christidi, Christos Kokkotis, Aimilios Gkantzios, Eleftherios Stefas, Pinelopi Vlotinou, Antonia Kaltsatou, Nikolaos Aggelousis and Konstantinos Vadikolias
Neurol. Int. 2023, 15(1), 83-99; https://doi.org/10.3390/neurolint15010008 - 16 Jan 2023
Cited by 6 | Viewed by 2390
Abstract
Predicting functional outcome following stroke is considered to be of key importance in an attempt to optimize overall stroke care. Although clinical prognostic tools have been widely implemented, optimal blood biomarkers might be able to yield additional information regarding each stroke survivor’s propensity [...] Read more.
Predicting functional outcome following stroke is considered to be of key importance in an attempt to optimize overall stroke care. Although clinical prognostic tools have been widely implemented, optimal blood biomarkers might be able to yield additional information regarding each stroke survivor’s propensity for recovery. Copeptin seems to have interesting prognostic potential poststroke. The present review aims to explore the prognostic significance of copeptin in stroke patients. Literature research of two databases (MEDLINE and Scopus) was conducted to trace all relevant studies published between 16 February 2012 and 16 February 2022 that focused on the utility of copeptin as a prognostic marker in acute stroke setting. 25 studies have been identified and included in the present review. The predictive ability of copeptin regarding both functional outcome and mortality appears to be in the range of established clinical variables, thus highlighting the added value of copeptin evaluation in stroke management. Apart from acute ischemic stroke, the discriminatory accuracy of the biomarker was also demonstrated among patients with transient ischemic attack, intracerebral hemorrhage, and subarachnoid hemorrhage. Overall, copeptin represents a powerful prognostic tool, the clinical implementation of which is expected to significantly facilitate the individualized management of stroke patients. Full article
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2022

Jump to: 2024, 2023

20 pages, 634 KiB  
Systematic Review
Elucidating the Role of Baseline Leukoaraiosis on Forecasting Clinical Outcome of Acute Ischemic Stroke Patients Undergoing Reperfusion Therapy
by Stella Karatzetzou, Dimitrios Tsiptsios, Anastasia Sousanidou, Foteini Christidi, Evlampia A. Psatha, Marilena Chatzaki, Sofia Kitmeridou, Erasmia Giannakou, Efstratios Karavasilis, Christos Kokkotis, Nikolaos Aggelousis and Konstantinos Vadikolias
Neurol. Int. 2022, 14(4), 923-942; https://doi.org/10.3390/neurolint14040074 - 10 Nov 2022
Cited by 5 | Viewed by 1900
Abstract
Stroke stands as a major cause of death and disability with increasing prevalence. The absence of clinical improvement after either intravenous thrombolysis (IVT) or mechanical thrombectomy (MT) represents a frequent concern in the setting of acute ischemic stroke (AIS). In an attempt to [...] Read more.
Stroke stands as a major cause of death and disability with increasing prevalence. The absence of clinical improvement after either intravenous thrombolysis (IVT) or mechanical thrombectomy (MT) represents a frequent concern in the setting of acute ischemic stroke (AIS). In an attempt to optimize overall stroke management, it is clinically valuable to provide important insight into functional outcomes after reperfusion therapy among patients presenting with AIS. The aim of the present review is to explore the predictive value of leukoaraiosis (LA) in terms of clinical response to revascularization poststroke. A literature research of two databases (MEDLINE and Scopus) was conducted in order to trace all relevant studies published between 1 January 2012 and 1 November 2022 that focused on the potential utility of LA severity regarding reperfusion status and clinical outcome after revascularization. A total of 37 articles have been traced and included in this review. LA burden assessment is indicative of functional outcome post-intervention and may be associated with hemorrhagic events’ incidence among stroke individuals. Nevertheless, LA may not solely guide decision-making about treatment strategy poststroke. Overall, the evaluation of LA upon admission seems to have interesting prognostic potential and may substantially enhance individualized stroke care. Full article
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