Naili Sofi Riasari1, Tugasworo D.2, Husni Amin3
1 Neurology Resident, Faculty of Medicine, Diponegoro University, Indonesia
2 Senior Lecture Staff of Neurology, Faculty of Medicine, Diponegoro University, Indonesia
3 Senior Lecture Staff of Neurology, Faculty of Medicine, Diponegoro University, Indonesia
Background: MMP-9 (Matrix Metalloproteinase-9) is a proteolytic enzyme that plays a role in stroke pathological process, because of its ability to degrade the epithelial basal membrane. Its secretion increases rapidly after ischemic stroke onset. It gives a promising biomarker of stroke prognosis.[1,2] Increased MMP-9 secretion raised hypothesis MMP-9 gene plays a role in the incidence of stroke susceptibility and its pathological process. The NIHSS (National Instititute of Health Stroke Scale) is clinical scale that provides information for predicting clinical outcomes of post-stroke patients. The aim of this study is to determine the role of MMP-9 rs3918242 genetic variant on the relationship between MMP-9 serum levels and changes in NIHSS scores in acute ischemic stroke.
Methode: Prospective cohort study, at RSUP. Dr. Kariadi Semarang during October 2018 - January 2019. Subjects meet the inclusion and exclusion criteria were taken for 8 cc venous blood samples onset 24-48 hours to examined for MMP-9 serum levels and MMP-9 genes; measured NIHSS scores on the 2nd, 7th and 14th day of stroke onset.
Results: There were 51 subjects with a mean serum MMP-9 level of 1.223.24 ng / ml (normal 169-705 ng / ml). Elevated serum MMP-9 levels were associated with worsening clinical outcomes on 7th day onset (OR 7.728, 95% CI, 1,827 - 32,683) and 14th day of onset (OR 10,031, 95% CI, 1,321 - 76,149). Subjects with CC genotype had improved clinical outcomes on day 14 of onset (OR 11,950, 95% CI, 2,286 - 62,480). ROC curve analysis obtained serum MMP-9 levels onset 24-48 hours with a cutoff point of 899.5 ng / ml. Serum MMP-9 levels above 899.5 ng / ml are predictors of worsening clinical outcome in acute ischemic stroke patients.