The Interaction of Stroke Risk Factors, Clinical Outcomes and Matrix Metalloproteinase 9 Levels with the Reduction of Vascular Endothelial Growth Factor A Levels at the Incidence of Brain Edema in Acute Ischemic Stroke Patients

Aims: To study the interaction between the reduction of vascular endothelial growth factor A/VEGF-A level with other variables at the incidence of brain edema in acute ischemic stroke patients.

Study Design: A prospective observational analytic case-control study.

Place and Duration of Study: Stroke Unit at the Dr. Sardjito General Hospital, Yogyakarta, Indonesia, between December 2010 and August 2011.

Methodology: Hospitalized acute ischemic stroke patients were recruited, comprising of 37 subjects in the brain edema group and 34 subjects in the non-brain edema group. Clinical characteristics of each subject were recorded and blood levels of VEGF-A and matrix metalloproteinase 9/MMP-9 were measured. Logistic regression analyses were performed to discover any potential independent variable that can influence the VEGF-A role at the incidence of brain edema.

Results: Multivariate analyses revealed that several variables were significantly interacted with the reduction of VEGF-A levels at the incidence of brain edema. These variables were the lipid profiles (model “D”; OR=4.26; 95%CI: 1.28-14.15), stroke risk factors (model “G”; OR=4.78; 95%CI: 1.38-16.56), MMP-9 (model “I”; OR=5.59; 95%CI: 1.58-19.78), and Gadjah Mada Stroke Scale/GMSS score (model “K”; OR=5.29; 95%CI: 1.47-19.08). Subsequent multivariate analysis by combining the model “D”, “G”, “I” and “K” resulted in a very elevated odds ratio (OR=16.72; 95%CI: 2.75-101.5).

Conclusion: The influence of VEGF-A reduction at the incidence of brain edema would be strongly enhanced by considering the combination of several independent variables, including the lipid profile, history of previous stroke risk factors, MMP-9 levels and GMSS score.