CLINICAL AND PROGNOSTIC SIGNIFICANCE OF LABORATORY BIOMARKERS IN ISCHEMIC STROKE

Abstract

Metabolic biomarkers and markers of endothelial dysfunction and hypercoagulation (ICAM-1, D-dimer, fibrinogen, homocysteine, and HbA1c) were found to have high prognostic value in assessing the risk of ischemic stroke in high-risk patients, supporting their inclusion in comprehensive laboratory screening. Objective: To evaluate the clinical and prognostic significance of metabolic biomarkers, markers of endothelial dysfunction, hypercoagulation, and homocysteine in patients at high risk of ischemic stroke and to determine their association with stroke risk indices. Materials and Methods: The study included 181 patients with different ischemic stroke risk profiles and 30 apparently healthy individuals in the control group. Patients were divided into three main clinical groups and one comparison group. Blood glucose, HbA1c, total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides, ICAM-1, D-dimer, fibrinogen, and homocysteine levels were measured in all participants. Statistical analysis was performed using analysis of variance (ANOVA) and Pearson correlation analysis. Results: Statistically significant differences were observed among the groups for all metabolic biomarkers (F=27.1–38.6; p<0.001). Blood glucose, HbA1c, total cholesterol, LDL-C, and triglyceride levels were significantly higher in all clinical groups than in the control group, whereas HDL-C levels were significantly lower. Significant differences were also found in markers of endothelial dysfunction and hypercoagulation (F=33.7–41.5; p<0.001). The highest levels of ICAM-1, D-dimer, fibrinogen, and homocysteine were recorded in the comparison group. Pearson correlation analysis demonstrated moderate to strong positive correlations between the stroke risk indices FSRS and CRI and ICAM-1 (r=0.69–0.74), D-dimer (r=0.72–0.76), fibrinogen (r=0.65–0.70), homocysteine (r=0.61–0.67), HbA1c (r=0.63–0.66), and LDL-C (r=0.60–0.64). Conclusion: Metabolic disorders, endothelial dysfunction, and hypercoagulation constitute a unified pathogenetic pathway in the development of ischemic stroke. ICAM-1, D-dimer, fibrinogen, homocysteine, and HbA1c have high prognostic value for ischemic stroke risk assessment and should be included in comprehensive laboratory screening protocols.