Circulating cytokine levels and 5-year vascular recurrence after stroke: A multicenter prospective cohort study.

IF 4.5 3区 医学 Q1 CLINICAL NEUROLOGY
Lanyue Zhang, Mohamad Ali Antabi, Jana Mattar, Omar El Bounkari, Rong Fang, Karin Waegemann, Felix J Bode, Sebastian Stösser, Peter Hermann, Thomas G Liman, Christian H Nolte, Benno Ikenberg, Kathleen Bernkopf, Wenzel Glanz, Daniel Janowitz, Annika Spottke, Michael Wolfgang Görtler, Silke Wunderlich, Inga Zerr, Gabor C Petzold, Matthias Endres, Jürgen Bernhagen, Martin Dichgans, Marios K Georgakis
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引用次数: 0

Abstract

Background and objectives: Anti-inflammatory therapies are tested in randomized trials for secondary stroke prevention. Detecting inflammatory biomarkers that predict vascular recurrence could optimize patient selection for these trials.

Methods: In a multicenter prospective cohort study, we measured plasma levels of 22 inflammatory cytokines in 486 acute stroke patients (474 ischemic strokes and 12 intracerebral hemorrhages; median age 68 years, 34% female, median 3 days post-stroke onset). Patients were followed for over 5 years through telephone and in-person interviews to record the occurrence of the following outcomes: (1) recurrent stroke or transient ischemic attack (TIA; primary outcome); (2) a composite of recurrent vascular events (stroke, TIA, acute coronary syndrome, hospital admission due to heart failure, and death; secondary outcome). Associations between cytokine levels and these outcomes were analyzed using Cox proportional hazards models adjusted for demographic and vascular risk factors.

Results: During the 5-year follow-up period, 59 patients (12.1%) experienced recurrent stroke or TIA, and 118 (24.3%) experienced recurrent vascular events. After adjustments for demographic and vascular risk factors, and correction for multiple comparisons, higher plasma levels of CD62E (adjusted Hazard Ratio (aHR)/SD increment: 1.63, 95%CI 1.22-2.20) and MIF (aHR: 1.56, 95%CI 1.18-2.06) in the acute phase after stroke were statistically significantly associated with increased risk of recurrent stroke or TIA. The associations followed a dose-response pattern across quartiles of CD62E and MIF levels. Adding baseline CD62E and MIF levels to models including age, sex, vascular risk factors, and baseline C-reactive protein (CRP) levels led to significant improvements in the prediction of 5-year risk of recurrent stroke or TIA (ΔC-index 0.030-0.050).

Conclusion: Among stroke patients, higher baseline levels of CD62E and MIF improved prediction of 5-year risk of recurrent stroke or TIA on top of vascular risk factors and CRP levels. Whether assessment of these cytokines could improve patient selection for secondary prevention trials of anti-inflammatory treatments, should be explored in future studies.

循环细胞因子水平与卒中后5年血管复发:一项多中心前瞻性队列研究。
背景和目的:抗炎疗法在二级卒中预防的随机试验中进行了测试。检测炎症生物标志物预测血管复发可以优化这些试验的患者选择。方法:在一项多中心前瞻性队列研究中,我们测量了486例急性卒中患者(474例缺血性卒中,12例脑出血;中位年龄68岁,34%为女性,中位卒中后3天)。通过电话和面对面访谈对患者进行5年以上的随访,记录以下结果的发生情况:(1)卒中复发或短暂性脑缺血发作(TIA);主要的结果);(2)复发性血管事件(中风、TIA、急性冠状动脉综合征、因心力衰竭住院和死亡)的复合;二次结果)。使用Cox比例风险模型对人口统计学和血管危险因素进行校正,分析细胞因子水平与这些结果之间的关系。结果:5年随访期间,59例(12.1%)发生卒中或TIA复发,118例(24.3%)发生血管事件复发。在对人口统计学和血管危险因素进行校正,并对多重比较进行校正后,卒中后急性期较高的血浆CD62E水平(校正危险比(aHR)/SD增量:1.63,95%CI 1.22-2.20)和MIF水平(aHR: 1.56, 95%CI 1.18-2.06)与卒中复发或TIA风险增加有统计学意义。这种关联遵循CD62E和MIF水平四分位数的剂量-反应模式。将基线CD62E和MIF水平添加到包括年龄、性别、血管危险因素和基线c反应蛋白(CRP)水平的模型中,可显著改善对5年卒中或TIA复发风险的预测(ΔC-index 0.030-0.050)。结论:在脑卒中患者中,在血管危险因素和CRP水平的基础上,较高的CD62E和MIF基线水平提高了对5年卒中复发或TIA风险的预测。这些细胞因子的评估是否可以改善抗炎治疗二级预防试验的患者选择,应在未来的研究中进行探讨。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
7.50
自引率
6.60%
发文量
102
期刊介绍: Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.
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