Serum VEGF Level in Acute Ischemic Stroke Patients Correlates With the Prognosis of Stroke

Abstract

Background & Objectives: Vascular endothelial growth factor (VEGF) with angiogenic and neuroprotective effects is increased in the ischemic brain. In the present study, we investigated whether serum VEGF level in acute stage of ischemic stroke patients with small vessel disease (SVD) or large vessel disease (LVD) correlates with long-term prognosis based on the difference of NIHSS scores between acute and chronic stages. Method: We evaluated patients with first-ever ischemic stroke definitely defined as the SVD (n=24) and the LVD (n=27) by the TOAST classification from March 2007 to July 2007. And age-matched normal persons (n=9) undergoing routine medical examinations who were shown to be disease free were used as controls. For evaluation of serum VEGF level, serum samples were taken immediately after admission (within 24 hours after stroke onset). On the first admission day, brain MRI and MR angiography were carried out in all patients. We also evaluated several demographic features including age and sex, history of diabetes mellitus, hypertension, and smoking, serum lipid profiles including total cholesterol level, TG level, HDL level, LDL level, and total cholesterol/HDL ratio, initial systolic and diastolic blood pressure, and initial NIHSS score, fasting glucose level, 2 hr-postprandial glucose level, hemoglobin A1C, ESR, CRP, serum WBC counts, and serum fibrinogen level. After 6 months, follow-up serum VEGF level and NIHSS in 31 patients (SVD, n=17 and LVD, n=14) was rechecked. Results: When compared with serum VEGF level in the control group, serum VEGF level in acute stage within 24 hours after stroke onset was much more increased in the LVD group (p=0.013), but not in the SVD group (p=0.375). Serum VEGF level in acute stage correlated with infarct volume (r=0.419; p=0.019; Spearman’s p). The increased serum VEGF level in acute stage was in proportion to the improvement of NIHSS score after 6 months (r=0.372; p=0.039; Spearman’s p). After adjustment for covariates, serum VEGF level in acute stage of ischemic stroke still significantly correlated with the long-term prognosis of ischemic stroke [OR=1.395 (1.001-1.813), p=0.047; COX regression analysis]. Conclusion: In conclusion, serum VEGF level in acute stage of ischemic stroke patients correlates with the long-term prognosis, so evaluating the level in acute stage of ischemic stroke might be helpful in predicting long-term prognosis.