Increased plasma thrombospondin-1 is associated with poor prognosis in ischemic stroke patients.

Background and aims: Thrombospondin-1 (THBS1) plays an important role in the modulation of coagulation, inflammatory response, vascular structure, and blood-brain barrier function, but its impact on clinical outcomes after ischemic stroke remains uncertain. We aimed to examine the relationship between plasma THBS1 levels and ischemic stroke prognosis in a multicenter observational study.

Methods and results: Plasma THBS1 levels at baseline were measured in 3511 ischemic stroke patients enrolled between August 2009 and May 2013 in 26 hospitals across China. The primary outcome was the composite outcome of death or major disability (modified Rankin Scale score ≥3) at 3 months after stroke onset. During the 3 months of follow-up, 865 patients experienced the primary outcome. After multivariate adjustment, high THBS1 levels were significantly associated with an increased risk of the primary outcome (odds ratio, 1.52; 95 % confidence interval [CI], 1.09-2.12; P_trend = 0.014) when 2 extreme tertiles were compared. Each interquartile range increase in THBS1 was associated with a 16 % (95 % CI, 3 %-32 %) increased risk of the primary outcome. The spline regression model revealed a positive linear dose-response association between THBS1 levels and risk of the primary outcome (P_linearity = 0.020). Adding THBS1 to a model containing conventional risk factors improved risk prediction for the primary outcome (net reclassification index: 13.63 %, P = 0.014; integrated discrimination index: 0.33 %, P = 0.036).

Conclusion: High plasma THBS1 levels are associated with poor prognosis at 3 months after ischemic stroke, suggesting that THBS1 may play a vital role in the development of ischemic stroke.