ABSTRACT
Aims: To study the correlation between the vascular endothelial growth factor A/VEGF-A level and 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: Seventy-one hospitalized acute ischemic stroke patients were recruited, consisting of 37 subjects in the brain edema group and 34 subjects in the non-brain edema group. Comparative analysis of the VEGF-A levels in blood was performed between the brain edema and non-brain edema groups. Results: The average level of VEGF-A in the brain edema group was 436 pg/mL and the one in the non-brain edema group was 746 pg/mL. This difference was statistically significant (95%CI: 5.5-615; P=.046). The proportion of VEGF-A levels less than the calculated cut-off point (638.3 pg/mL) in the brain edema group were significantly greater than the ones in the non-brain edema (83.78% and 58.82%, respectively; OR=3.6; 95%CI=1.06-13.26; P=.020). Conclusions: The decreased levels of VEGF-A in blood were correlated with the incidence of brain edema in acute ischemic stroke patients.
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.