• Leonardo Lorente, María M Martín, Antonia Pérez-Cejas, Agustín F González-Rivero, Rafael Sabatel, Luis Ramos, Mónica Argueso, Jordi Solé-Violán, Juan J Cáceres, Alejandro Jiménez, and Victor García-Marín.
• Intensive Care Unit, Hospital Universitario de Canarias, Ofra s/n, 38320 La Laguna, Santa Cruz de Tenerife, Spain.
• Brain Sci. 2020 Feb 27; 10 (3).

ObjectiveCaspase-cleaved cytokeratin (CCCK)-18 could appear in blood during apoptosis. In two different studies, on day 1 of cerebral infarction and at 72 hours of cerebral infarction, respectively, higher circulating CCCK-18 levels were found in non-surviving than in surviving patients. The objective of this study was to analyze the ability of these levels to predict mortality at any time during the first week of cerebral infarction.MethodsPatients with malignant middle cerebral artery infarction (MMCAI) were included and the diagnosis criteria were the presence, observed in a computed tomography, of an acute cerebral infarction in at least 50% of this territory and midline shift, and an acute neurological deterioration with a Glasgow Coma Scale ≤ 8. Serum CCCK-18 levels at days 1, 4 and 8 of MMCAI were determined.ResultsSerum concentrations of CCCK-18 at days 1, 4 and 8 of MMCAI were higher in non-surviving (n = 34) than in surviving patients (n = 34). Serum CCCK-18 concentrations at days 1, 4 and 8 of MMCAI had an area under curve (95% CI) used to predict a 30-day mortality of 0.83 (0.72--0.91; p < 0.001), 0.78 (0.65-0.89; p < 0.001) and 0.82 (0.68-0.92; p < 0.001).ConclusionsThe novel finding is that serum levels of CCCK-18 levels at any time after the first week of MMCAI could help predict 30-day mortality.

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