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Post‐stroke blood–brain barrier disruption predicts poor outcome in patients enrolled in the ACTION study
Author(s) -
Leigh Richard,
Hitomi Emi,
Hutchison R. Matthew,
Elkins Jacob
Publication year - 2021
Publication title -
journal of neuroimaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.822
H-Index - 64
eISSN - 1552-6569
pISSN - 1051-2284
DOI - 10.1111/jon.12862
Subject(s) - medicine , context (archaeology) , stroke (engine) , logistic regression , post hoc analysis , thrombolysis , cohort , perfusion scanning , perfusion , mechanical engineering , paleontology , myocardial infarction , engineering , biology
Background and Purpose A prior study found a link between post‐stroke blood–brain barrier disruption and functional outcomes. The current study aimed to replicate this finding in a cohort of patients recruited in the context of a randomized clinical trial. Methods The ACTION trial was a study of natalizumab in acute stroke patients. Patients with MRI‐perfusion weighted imaging (PWI) were included in this post‐hoc analysis. Blood‐brain permeability images (BBPI) were calculated from the PWI source images. Mean BBPI values from the 24 h time point were compared with modified Rankin scores (mRS) at 5, 30, and 90‐day assessments using linear regression. Good functional outcome (mRS< = 1) was compared with mean BBPI using logistic regression. Results One hundred and nineteen patients were included in the analysis (median age = 74, 43% female). Higher mean BBPI was associated with worse mRS at 5 days ( p = 0.002; r 2 = 0.078) and 30 days ( p = 0.036; r 2 = 0.039) but did not reach statistical significance at 90 days ( p = 0.30; r 2 = 0.010). When removing high‐value outliers, all outcome measures showed a stronger relationship with mean BBPI. Logistic regression found that with every 1% increase in mean BBPI measured 24 h after the stroke, the likelihood of achieving a good functional outcome at 90 days is decreased by half (OR = 0.53; CI = 0.30:0.95; p = 0.032). Conclusions With sufficient image quality, elevated BBPI measured in the days after an ischemic event is predictive of worse functional outcome and may serve as a biomarker for post‐stroke inflammation.