Diagnostic Accuracy of Matrix Metalloproteinase-9 (MMP-9) in Predicting Hemorrhagic Transformation After Acute Ischemic Stroke: A Systematic Review and Meta-analysis
Bassel Alrabadi1, Ahmad Alkasem2, Esraa Mohammed Marei3, Elsayed Kshk4, Anas Elgenidi5
1Jordan University of Science and Technology, 2Mutah University, 3Minia University, 4Department of Cardiology, Damanhour Teaching Hospital, 5Department of Neurology, Mayo Clinic
Objective:
: To assess the diagnostic accuracy of matrix metalloproteinase (MMP) levels in predicting hemorrhagic transformation (HT) after acute ischemic stroke (AIS).
Background:
MMP-9 contributes to neuroinflammation and blood–brain barrier disruption following AIS and may serve as a plausible blood biomarker for HT.
Design/Methods:
A comprehensive systematic search of Medline (via PubMed), Scopus, Web of Science, Cochrane Library, and EMBASE was conducted to identify studies measuring MMP-9 in patients with AIS and HT. The mean difference between patients with AIS and HT and those without HT was calculated. Heterogeneity was assessed using the chi-square test and the I² statistic. Diagnostic test accuracy was evaluated, and the area under the curve (AUC) was plotted using Meta-DiSc software.
Results:
Nine studies involving 1,051 participants (641 men and 560 women) were included. MMP-9 levels were significantly higher in patients with HT, with a pooled mean difference of 70.51 ng/mL (95% CI: 35.47–105.5). The pooled diagnostic sensitivity and specificity were 79% (95% CI: 0.791–0.841) and 80% (95% CI: 0.673–0.881), respectively. The combined positive likelihood ratio was 3.88, the negative likelihood ratio 0.26, and the diagnostic odds ratio 14.75, with no significant heterogeneity (I² = 0).
Conclusions:
MMP-9 levels are significantly higher in patients who develop HT after AIS. Moreover, MMP-9 demonstrates good diagnostic accuracy and may serve as a useful predictive biomarker for HT.
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