Pharma Focus Asia

Association of Serum Biomarkers with Early Neurologic Improvement after Intravenous Thrombolysis in Ischemic Stroke

Camila Freitas dos Santos ,Mariana Gobbo Braz ,Nayara Micarelli de Arruda ,Laura Caram ,Duelene Ludimila Nogueira ,Suzana Erico Tanni,Irma de Godoy ,Renata Ferrari

Early neurologic improvement (ENI) after intravenous thrombolysis is associated with favorable outcome, but associated serum biomarkers were not fully determined. We aimed to investigate the issue based on a prospective cohort.

Stroke is the second leading cause of disability and mortality worldwide, which prevalence increased annually in China. Intravenous alteplase is recommended as the most effective treatment for acute ischemic stroke within 4.5 hours of symptom onset. Early neurologic improvement (ENI) after intravenous thrombolysis is associated with vessel recanalization and predicts functional outcome at 90 days.

From August 2018 to July 2019, patients receiving intravenous thrombolysis within 4.5 hours were consecutively screened to collect blood samples before thrombolysis from five selected hospitals participating in the INTRECIS study. The registry study is nationwide, multicenter, and prospective, which enrolled consecutive adult patients who were eligible for intravenous thrombolysis within 4.5 hours. Details of the trial design and primary outcomes analyses have been previously reported.

Up to date, only a few biomarkers, such as ADAMTS13 activity, Aquaporin-4, leukocyte count, and neutrophil to lymphocyte ratio, were found to be associated with post-thrombolytic ENI in stroke. The nine biomarkers identified in the present study were previously reported in ischemic stroke which involved the process of inhibiting development of atherosclerotic plaques, vascular remodeling, neural regeneration, and inflammatory response.

We thank all participating hospitals, relevant clinicians, and statistician. We also thank all patients who participated in the present study.

Citation: Cui Y, Wang X-H, Zhao Y, Chen S-Y, Sheng B-Y, Wang L-H, et al. (2022) Association of serum biomarkers with early neurologic improvement after intravenous thrombolysis in ischemic stroke. PLoS ONE 17(10): e0277020.

Editor: Wen-Jun Tu, Chinese Academy of Medical Sciences and Peking Union Medical College, CHINA

Received: July 23, 2022; Accepted: October 17, 2022; Published: October 31, 2022.

Copyright: © 2022 Cui et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: The raw datasets used in the study can be found in the Zenodo online repository (

Funding: The study was funded by grants from National Key R&D Program of China (2017YFC1308203), and the Project on Research and Application of Effective Intervention Techniques for Chinese Stroke Guidelines from the National Health and Family Planning Commission in China (GN-2016R0008). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

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