Neopterin and kynurenic acid as predictors of stroke recurrence and mortality: a multicentre prospective cohort study on biomarkers of inflammation measured three months after ischemic stroke

BMC Neurology

Per-Magne Ueland¹  Arve Ulvik¹  Jörg Assmus²  Anne-Brita Knapskog³  Tom Eirik Mollnes⁴  Mala Naik⁵  Torunn Askim⁶  Ingvild Saltvedt⁷  Katinka Nordheim Alme⁸  Halvor Næss⁹ 

[1] Bevital AS, Bergen, Norway;Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway;Department of Geriatric Medicine, Oslo University Hospital. Ullevaal, Oslo, Norway;Department of Immunology, Oslo University Hospital and University of Oslo, Oslo, Norway;Research Laboratory, Nordland Hospital, Bodø, and K.G. Jebsen TREC, University of Tromsø, Tromsø, Norway;Centre of Molecular Inflammation Research, NTNU-Norwegian University of Science and Technology, Trondheim, Norway;Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway;Department of Clinical Science (K2), University of Bergen, Bergen, Norway;Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway;Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway;Department of Geriatrics, Clinic of internal medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway;Institute of Clinical Medicine (K1), University of Bergen, Bergen, Norway;Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway;Institute of Clinical Medicine (K1), University of Bergen, Bergen, Norway;Department of Neurology, Haukeland University Hospital, Bergen, Norway;Centre for age-related medicine, Stavanger University Hospital, Stavanger, Norway;

关键词: Sedentary behaviour;    Inflammation;    Immune modulation;    Vascular disease;    Kynurenine pathway;    Stroke;   

DOI  :  10.1186/s12883-021-02498-w

来源: Springer

【 摘 要 】

BackgroundChronic low-grade inflammation is associated with both ischemic stroke and sedentary behaviour. The aim of this study was to investigate the predictive abilities of biomarkers of inflammation and immune modulation associated with sedentary behaviour for ischemic stroke recurrence and mortality in a stroke population.MethodsPatients admitted to hospital for acute stroke were recruited to the prospective multicentre cohort study, the Norwegian Cognitive Impairment After Stroke (Nor-COAST) study, from May 2015 until March 2017. Patients with ischemic stroke, blood samples available from the three-month follow-up, and no stroke recurrence before the three-month follow-up were included. Serum was analysed for C-reactive protein (CRP) with high-sensitive technique, and plasma for interleukin-6 (IL-6), neopterin, pyridoxic acid ratio index (PAr-index: 4-pyridoxic acid: [pyrioxal+pyridoxal-5′-phosphate]) and kynurenic acid (KA). Ischemic stroke recurrence and death were identified by the Norwegian Stroke Registry and the Cause of Death Registry until 31 December 2018.ResultsThe study included 354 patients, 57% male, mean age 73 (SD 11) years, mean observation time 2.5 (SD 0.6) years, and median National Institute of Health Stroke Scale of 0 (IQR 1) at three months. CRP was associated with mortality (HR 1.40, CI 1.01, 1.96, p = 0.046), and neopterin was associated with the combined endpoint (recurrent ischemic stroke or death) (HR 1.52, CI 1.06, 2.20, p = 0.023), adjusted for age, sex, prior cerebrovascular disease, modified Rankin Scale, and creatinine. When adding neopterin and KA to the same model, KA was negatively associated (HR 0.57, CI 0.33, 0.97, p = 0.038), and neopterin was positively associated (HR 1.61, CI 1.02, 2.54, p = 0.040) with mortality. Patients with cardioembolic stroke at baseline had higher levels of inflammation at three months.ConclusionNeopterin might be a valuable prognostic biomarker in stroke patients. The use of KA as a measure of anti-inflammatory capacity should be investigated further.Trial registrationThe study was registered at Clinicaltrials.gov (NCT02650531). First posted on 08/01/2016.

【 授权许可】

CC BY