• 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, La Laguna, 38320, Santa Cruz de Tenerife, Spain. lorentemartin@msn.com.
• Neurocrit Care. 2019 Dec 1; 31 (3): 486-493.

PurposeCirculating caspase-3 levels at 24 h of ischemic stroke were found to be associated with poorer functional neurological outcome in a previous study. The aim of this study was to determine whether there is an association between serum caspase-3 levels and early mortality in patients with malignant middle cerebral artery infarction (MMCAI).MethodsWe included patients with MMCAI defined as computer tomography showing ischemic changes in more than 50% of the middle cerebral artery territory and Glasgow Coma Scale ≤ 8. Serum caspase-3 levels at days 1, 4, and 8 of MMCAI were determined.ResultsNon-surviving MMCAI (n = 34) showed higher serum caspase-3 levels at days 1 (p < 0.001), 4 (p = 0.001), and 8 (p = 0.01) than surviving patients (n = 34). We found that the area under the curve of serum caspase-3 levels for prediction of mortality at 30 days was 88% (95% CI = 78-95%; p < 0.001). Multiple logistic regression showed that serum caspase-3 levels were associated with 30-day mortality (OR = 51.25; 95% CI = 8.30-316.31; p < 0.001).ConclusionsThe novel and more important findings of our study were that high serum caspase-3 levels were associated with mortality in MMCAI patients.

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