The Interaction of Stroke Risk Factors, Clinical Outcomes and Matrix Metalloproteinase 9 Levels with the Reduction of Vascular Endothelial Growth Factor A Levels at the Incidence of Brain Edema in Acute Ischemic Stroke Patients
Ismail Setyopranoto *
Department of Neurology, Faculty of Medicine, Gadjah Mada University and Dr. Sardjito General Hospital, Yogyakarta, Indonesia
Samekto Wibowo
Department of Neurology, Faculty of Medicine, Gadjah Mada University and Dr. Sardjito General Hospital, Yogyakarta, Indonesia
Ahmad Hamim Sadewa
Department of Biochemistry, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia
Rusdi Lamsudin
Department of Neurology, Faculty of Medicine, Gadjah Mada University and Dr. Sardjito General Hospital, Yogyakarta, Indonesia.
*Author to whom correspondence should be addressed.
Abstract
Aims: To study the interaction between the reduction of vascular endothelial growth factor A/VEGF-A level with other variables at the incidence of brain edema in acute ischemic stroke patients.
Study Design: A prospective observational analytic case-control study.
Place and Duration of Study: Stroke Unit at the Dr. Sardjito General Hospital, Yogyakarta, Indonesia, between December 2010 and August 2011.
Methodology: Hospitalized acute ischemic stroke patients were recruited, comprising of 37 subjects in the brain edema group and 34 subjects in the non-brain edema group. Clinical characteristics of each subject were recorded and blood levels of VEGF-A and matrix metalloproteinase 9/MMP-9 were measured. Logistic regression analyses were performed to discover any potential independent variable that can influence the VEGF-A role at the incidence of brain edema.
Results: Multivariate analyses revealed that several variables were significantly interacted with the reduction of VEGF-A levels at the incidence of brain edema. These variables were the lipid profiles (model “D”; OR=4.26; 95%CI: 1.28-14.15), stroke risk factors (model “G”; OR=4.78; 95%CI: 1.38-16.56), MMP-9 (model “I”; OR=5.59; 95%CI: 1.58-19.78), and Gadjah Mada Stroke Scale/GMSS score (model “K”; OR=5.29; 95%CI: 1.47-19.08). Subsequent multivariate analysis by combining the model “D”, “G”, “I” and “K” resulted in a very elevated odds ratio (OR=16.72; 95%CI: 2.75-101.5).
Conclusion: The influence of VEGF-A reduction at the incidence of brain edema would be strongly enhanced by considering the combination of several independent variables, including the lipid profile, history of previous stroke risk factors, MMP-9 levels and GMSS score.
Keywords: Acute ischemic stroke, VEGF-A, risk factors, MMP-9, brain edema