Deans' stroke musings: Elevated Serum Lactate Dehydrogenase Predicts Unfavorable Outcomes After rt-PA Thrombolysis in Ischemic Stroke Patients

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Thursday, April 28, 2022

Elevated Serum Lactate Dehydrogenase Predicts Unfavorable Outcomes After rt-PA Thrombolysis in Ischemic Stroke Patients

What good did this research do in getting survivors recovered? Predictions of recovery failure DO ABSOLUTELY NOTHING!

Elevated Serum Lactate Dehydrogenase Predicts Unfavorable Outcomes After rt-PA Thrombolysis in Ischemic Stroke Patients

Huijuan Jin¹^†,

Rentang Bi¹^†,

Jichuan Hu²^†,

Da Xu¹,

Ying Su¹,

Ming Huang³,

Qiwei Peng¹,

Zhifang Li¹,

Shengcai Chen¹^* and

Bo Hu¹^*

¹Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
²Department of Neurology, People's Hospital of Dongxihu District, Wuhan, China
³Department of Neurology, Hubei Provincial Hospital of Integrated Chinese and Western Medicine, Hubei University of Chinese Medicine, Wuhan, China

Background and Purpose: Currently, acute ischemic stroke (AIS) is one of the most common and serious diseases in the world and is associated with very high mortality and morbidity even after thrombolysis therapy. This study aims to research the relationship between lactic dehydrogenase (LDH) and prognosis in AIS patients treated with intravenous rtPA.

Method: This study (a Multicenter Clinical Trial of Revascularization Treatment for Acute Ischemic Stroke, TRAIS) included 527 AIS patients in 5 cooperative medical institutions in China from January 2018 to February 2021. The primary outcome was major disability and death within 3 months (mRS score of 3–6), and the secondary outcomes were early neurological improvement (ENI), early neurological deterioration (END), moderate-severe cerebral edema (CE), and symptomatic intracranial hemorrhage (sICH).

Results: The mean age of the 527 patients was 65.6 ± 11.7 years, and the median baseline NIHSS score was 4 (interquartile range, 2–7). The median serum LDH level was 184 U/L (interquartile range, 163–212 U/L). In total, 287 (54.5%) patients acquired ENI, 68 (13.0%) patients suffered END, 53 (12.1%) patients were observed with moderate-severe CE, and 28 (6.2%) patients showed sICH. Within 3 months, 127 (25.15%) patients experienced the primary outcome and 42 (8.3%) patients died. Serum LDH levels before thrombolysis showed an independent association with the risk of primary outcome [adjusted odds ratio, 3.787; (95% CI, 1.525–9.404); P = 0.014]. When log-transformed LDH increased each standard deviation, the risk of primary outcome was raised by 80.1% (95% CI, 28.9–251.7%). A positive linear dependence between the risk of primary outcome and serum LDH levels (P of linearity = 0.0248, P of non-linearity = 0.8284) was shown in multivariable-adjusted spline regression models. Pre-thrombolysis LDH quartile also provided a conventional risk model and significant improvement of the prediction for clinical outcomes, with a net reclassification improvement index (NRI) = 41.86% (P < 0.001) and integrated discrimination improvement (IDI) = 4.68% (P < 0.001).

Conclusions: Elevated serum LDH levels predicted unfavorable clinical outcomes after intravenous thrombolysis in AIS patients.

Introduction

Acute ischemic stroke (AIS) is currently one of the most disabling and lethal diseases in the world (1). Intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) as well as endovascular therapy is the most effective primary modality of therapy (2, 3). However, a significant number of patients who receive intravenous rt-PA therapy still face the threat of complications such as hemorrhage transformation and cerebral edema (CE), with unfavorable recovery of neurological function (3, 4). Therefore, it is significant to explore novel prognostic biomarkers in AIS patients for clinical decision making.

Lactate dehydrogenase (LDH) is a critical enzyme of the anaerobic metabolic pathway and is mainly distributed in the cytoplasm and mitochondria of various tissues, including the brain, heart, liver, and lung under physiological conditions (5, 6). Once the tissue is injured, LDH is released to the extracellular space and leads to an increased serum LDH level. Thus, LDH has been regarded as a biomarker of both tissue injury and prognosis in many diseases, including acute myocardial infarction, acute hepatitis, and acute lung injury (7–10). Presumably, LDH gets rapidly upregulated in brain parenchyma in response to ischemia and hypoxia after AIS, and leaks into circulating blood with the aggravation of cerebral infarction and peripheral edema. LDH has been observed to be released from brain tissue in animal models of brain injury, including ischemic stroke, and has been applied as a marker of brain tissue injury in basial experiments (11–13). Clinically, LDH is found to be elevated in the serum and cerebrospinal fluid of patients with ischemic stroke and related to the occurrence of stroke (14).

The relationship between LDH levels and clinical outcomes in AIS patients has never been thoroughly studied (15, 16). This study aimed to analyze the correlation between serum LDH and clinical outcomes in patients receiving intravenous rt-PA treatment.