• Leonardo Lorente, María M Martín, Agustín F González-Rivero, Rafael Sabatel, Luis Ramos, Mónica Argueso, Juan J Cáceres, Jordi Solé-Violán, Andrea Alvarez-Castillo, Alejandro Jiménez, Juan M Borreguero-León, and Victor García-Marín.
• Intensive Care Unit, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain. Electronic address: lorentemartin@msn.com.
• World Neurosurg. 2019 Dec 1; 132: e630-e636.

BackgroundHigher circulating soluble cluster of differentiation 40 ligand (sCD40L) levels at admission of an ischemic stroke have been found in nonsurvivor than in survivor patients. The objectives of this study were to determine whether serum sCD40L levels during the first week of a severe malignant middle cerebral artery infarction (MMCAI) are higher in nonsurvivor than in survivor patients and whether they could be used as biomarker of mortality prediction.MethodsThis multicenter study included patients with severe MMCAI (defined as Glasgow Coma Scale score <9). We determined serum sCD40L concentrations at days 1, 4, and 8 and performed receiver operating characteristic analyses to determine their capacity for 30-day mortality prediction.ResultsNonsurvivors (n = 34) showed higher sCD40L levels on days 1 (P < 0.001), 4 (P = 0.004), and 8 (P < 0.001) than did survivor patients (n = 34). Areas under the curve of serum sCD40L concentrations at days 1, 4, and 8 of severe MMCAI for 30-day mortality prediction were 83% (P < 0.001), 89% (P < 0.001), and 87% (P < 0.001), respectively.ConclusionsThe findings that nonsurvivors showed higher serum sCD40L levels during the first week of MMCAI than did survivors and that serum sCD40L levels during the first week of MMCAI could be used as a mortality predictor biomarker are 2 novel findings.Copyright © 2019 Elsevier Inc. All rights reserved.

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