Cystatin C is a Potential Predictor of Unfavorable Outcomes for Cerebral Ischemia with IV‐tPA Treatment: A Multicenter Prospective Nested Case‐Control Study

BACKGROUND This study is to explore whether Cystatin C could be used as a potential predictor of the clinical outcomes in acute ischemic stroke patients treated by intravenous tissue plasminogen activator. METHODS We performed an observational study with a retrospective analysis of data from 125 acute ischemic stroke patients with intravenous thrombolysis. General linear models were applied to assess Cystatin C levels between groups with different outcomes; logistic regression analysis and receiver operating characteristic curves were adopted to identify the association between Cystatin C and the therapeutic effects. RESULTS Compared with the Good&Sustained Benefit group (≥4 reduction in National Institutes of Health Stroke Scale or a score of 0-1 at 24 hours and 7 days) and the Good Functional Outcome group (modified Rankin Scale 0-2 at 90 days), serum Cystatin C baseline levels were increased in the non-Good&Sustained Benefit and non-Good Functional Outcome groups. Logistic regression analysis found that Cystatin C was an independent negative prognostic factor for Good&Sustained Benefit (odds ratio = 0.010, p = 0.005) and Good Functional Outcome (odds ratio = 0.011, p = 0.021) after adjustment for potential influencing factors. Receiver operating characteristic curves showed the Cystatin C-involved combined models provided credible efficacy for predicting post-90-day favorable clinical outcomes (area under the curve = 0.86, p < 0.001). CONCLUSIONS Elevated serum Cystatin C is independently associated with unfavorable clinical outcomes after intravenous tissue plasminogen activator therapy in acute ischemic stroke. Our findings provide new insights into discovering potential mediators for neuropathological process or treatment in stroke.