AUTHOR=Zhao Xiaoxia , Yang Siyu , Lei Ruining , Liu Yi , Duan Qiaoyan , Li Jundong , Sun Lei 

TITLE=Value of novel thrombotic markers for predicting occurrence of the malignant cerebral artery infarction: a prospective clinical study

JOURNAL=Frontiers in Neurology

VOLUME=Volume 14 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1238742

DOI=10.3389/fneur.2023.1238742

ISSN=1664-2295

ABSTRACT=Objective This study investigated the diagnostic performance of thrombinantithrombin complex (TAT), plasmin-α2 plasmin inhibitor complex (PIC), tissue plasminogen activator-plasminogen activator inhibitor complex (t-PAIC) and thrombomodulin (TM) in predicting the progression of massive cerebral infarction to malignant cerebral artery infarction. Method A total of 71 patients with massive cerebral infarction confirmed by imaging examination were divided into malignant cerebral artery infarction group (MCAI) and non-malignant cerebral artery infarction group (NMCAI) based on whether they progressed to MCAI after admission. TAT, PIC, t-PAIC and TM were measured immediately after admission. The predictive performance was analyzed by receiver characteristic operating curve (ROC). ResultThe median plasma concentrations of TM, PIC, TAT,and t-PAIC in MCAI patients at admission were 10.65 IU/mL, 1.17 μg/mL, 12.25 ng/mL, and 13.85 ng/mL, respectively, which were higher than those in NMCAI patients (9.00 IU/mL, 1.07 μg/mL, 4.60 ng/mL, and 8.70 ng/mL), and the difference was statistically significant (P=0.045, P=0.035, P=0.004, and P=0.003). Elevated plasma t-PAIC concentration was shown to be an independent risk factor for progression of massive cerebral infarction to MCAI (OR=1.131) by multivariate logistic regression analysis .ROC curve analysis showed that t-PAIC was the best predictor of MCAI (AUC=74.7%), with a sensitivity of 75.0% and specificity of 75.9% when t-PAIC concentration was ≥12.4ng/mL; TAT had the highest specificity in predicting MCAI, with a specificity of 90.7% when the TAT concentration was ≥13.5ng/mL. Conclusion The detection of PIC, TAT, t-PAIC, and TM is a comprehensive assessment of vascular endothelial damage and activation of the coagulation and fibrinolytic systems, and has predictive value for poor prognosis in patients with MCAI patients. The widespread use of these tests will likely greatly improve the early diagnosis rate of MCAI.