Abstract:
OBJECTIVE:To study the prognostic significance of multiple novel biomarkers in combination after ischemic stroke. METHODS:We derived data from the China Antihypertensive Trial in Acute Ischemic Stroke, and 12 informative biomarkers were measured. The primary outcome was the combination of death and major disability (modified Rankin Scale score ≥3) at 3 months after ischemic stroke, and secondary outcomes included major disability, death, and vascular events. RESULTS:In 3,405 participants, 866 participants (25.4%) experienced major disability or died within 3 months. In multivariable analyses, elevated high-sensitive C-reactive protein, complement C3, matrix metalloproteinase-9, hepatocyte growth factor, and antiphosphatidylserine antibodies were individually associated with the primary outcome. Participants with a larger number of elevated biomarkers had increased risk of all study outcomes. The adjusted odds ratios (95% confidence intervals) of participants with 5 elevated biomarkers were 3.88 (2.05-7.36) for the primary outcome, 2.81 (1.49-5.33) for major disability, 5.67 (1.09-29.52) for death, and 4.00 (1.22-13.14) for vascular events, compared to those with no elevated biomarkers. Simultaneously adding these 5 biomarkers to the basic model with traditional risk factors led to substantial reclassification for the combined outcome (net reclassification improvement 28.5%, p < 0.001; integrated discrimination improvement 2.2%, p < 0.001) and vascular events (net reclassification improvement 37.0%, p = 0.001; integrated discrimination improvement 0.8%, p = 0.001). CONCLUSION:We observed a clear gradient relationship between the numbers of elevated novel biomarkers and risk of major disability, mortality, and vascular events. Incorporation of a combination of multiple biomarkers observed substantially improved the risk stratification for adverse outcomes in ischemic stroke patients.
journal_name
Neurologyjournal_title
Neurologyauthors
Zhong C,Zhu Z,Wang A,Xu T,Bu X,Peng H,Yang J,Han L,Chen J,Xu T,Peng Y,Wang J,Li Q,Ju Z,Geng D,He J,Zhang Ydoi
10.1212/WNL.0000000000006717subject
Has Abstractpub_date
2019-01-22 00:00:00pages
e295-e304issue
4eissn
0028-3878issn
1526-632Xpii
WNL.0000000000006717journal_volume
92pub_type
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