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Prognostic value of plasma chitotriosidase activity in acute stroke patients

Authors

  • Alejandro Bustamante,

    1. Neurovascular Research Laboratory, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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    • These authors contributed equally to this work.
  • Carmen Dominguez,

    1. Biochemistry and Molecular Biology Research Centre for Nanomedicine, Hospital Universitari Vall d'Hebron, Barcelona, Spain
    2. Centre for Biomedical Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
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    • These authors contributed equally to this work.
  • Víctor Rodriguez-Sureda,

    1. Biochemistry and Molecular Biology Research Centre for Nanomedicine, Hospital Universitari Vall d'Hebron, Barcelona, Spain
    2. Centre for Biomedical Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
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  • Angel Vilches,

    1. Biochemistry and Molecular Biology Research Centre for Nanomedicine, Hospital Universitari Vall d'Hebron, Barcelona, Spain
    2. Centre for Biomedical Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
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  • Ana Penalba,

    1. Neurovascular Research Laboratory, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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  • Dolors Giralt,

    1. Neurovascular Research Laboratory, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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  • Teresa García-Berrocoso,

    1. Neurovascular Research Laboratory, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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  • Victor Llombart,

    1. Neurovascular Research Laboratory, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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  • Alan Flores,

    1. Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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  • Marta Rubiera,

    1. Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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  • Carlos Molina,

    1. Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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  • José Alvarez-Sabín,

    1. Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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  • Joan Montaner

    Corresponding author
    1. Neurovascular Research Laboratory, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
    2. Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
    • Correspondence: Joan Montaner*, Neurovascular Research Laboratory, Institut de Recerca, Pg. Vall d'Hebron, 119-129 Hospital Universitari Vall d'Hebron, 08035 Barcelona, Spain.

      E-mail: 31862jmv@comb.cat

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  • Conflicts of interest: The authors confirm that there are no conflicts of interest.

Abstract

Background and aims

Chitotriosidase, a component of innate immunity, constitutes a sensitive parameter of macrophage activation and its elevated plasma activity reflects an inflammatory response. Given the deleterious effects of inflammation in brain ischemia, we aimed to assess the prognostic value of chitotriosidase activity in acute stroke patients.

Methods

The study comprised 159 acute stroke patients and 51 age-matched controls. Plasma chitotriosidase activity was serially determined by fluorometric assay. Short-term neurological outcome was determined at 48 h and functional outcome at three-months. Predictors of neurological and functional outcome were determined via multivariate analysis, and the additional predictive value of chitotriosidase was tested with the Integrated Discrimination Index and the Net Reclassification Improvement.

Results

Stroke patients showed increased levels of baseline chitotriosidase activity compared to controls [114·2 (74·65–182·95) nmol/ml/h vs. 54·4 (32·7–76·4); P < 0·0001]. Chitotriosidase activity (<118·75) was found to be an independent predictor of neurological improvement at 48 h (odds ratio: 3·25; 95% confidence interval: 1·54–6·85; P = 0·002), and the addition of plasma chitotriosidase activity showed a better prediction of improvement at 48 h (Integrated Discrimination Index = 5·7%, Net Reclassification Improvement = 11·6%, P < 0·05) over the predictive model constituted only with clinical information. Although patients disabled at three-months showed higher baseline chitotriosidase levels, it was not an independent predictor of long-term disability.

Conclusions

Baseline chitotriosidase activity in acute stroke patients treated with tissue plasminogen activator (tPA) may constitute a prognostic predictor of short-term outcome, adding a moderate additional predictive value. Our results underline the deleterious role of inflammation in acute stroke patients.

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