Fibronectin concentration in the prediction of survival and symptomatic transformation in patients with ischemic stroke treated by thrombolysis

Background. Thrombolytic therapy (TLT) for ischemic stroke has a high proven efficacy, but is often accompanied by symptomatic hemorrhagic transformation (sHT) of the lesion, which can lead to lethal outcome (LO). The thrombolysis products in elimination from the bloodstream are opsonized by proteins, in particular fibronectin. Fibronectin is also involved in the blood clotting, which is activated in stroke. The aim of this study was to assess dynamics and interactions of fibronectin plasma concentration with the development of survival and symptomatic HT in patients with ischemic stroke treated TLT. Materials and methods. The study included 66 patients in the acute period of ischemic stroke. The stratification criteria were: the lack of sHT and LO, sHT without LO, LO without sHT, LO and sHT. Plasma fibronectin concentration was determined by ELISA at admission of patients to the hospital, after 0-4 hours after TLT, at 1th, 2th, 3-5th, and 7th days. Statistical processing of data was made using the software SPSS 8.0 and Microsoft Excel 2013. Results. Patients before TLT had fibronectin concentration within the reference limits, upper values of the dispersion measure are negligible and statistically insignificant higher then reference limits. In the 1th day after TLT we observed a statistically significant increase in fibronectin concentration with subsequent normalization. Surviving patients with sHT had statistically significantly higher level of fibronectin before TLT and in the first 4 hours after TLT than patients without sHT. Threshold value was 150 mg/ml. The probability of no symptomatic HT in surviving patients with a concentration of fibronectin ≤150 mg/ml was 7.5 times higher than with concentrations more than 150 mg/ml. Conclusion. Higher fibronectin concentrations in patients with sHT, probably due to opsonized functions of this protein that removes low molecular weight products of thrombolysis and degradation products of the cellular protein matrix from the bloodstream. Probably compensatory increase of fibronectin can be considered as a marker of high concentration of the near-wall proteolysis products. They can cause vascular wall damage and hemorrhagic infiltration of the lesion.

ischemic stroke, fibronectin, thrombolytic therapy, symptomatic hemorrhagic transformation, lethal outcome