Baseline Blood Biomarkers and Neurological Instability after Acute Ischemic Stroke: A Prospective Cohort Study

Background: Neurological change in the modified Rankin Scale (ΔmRS) implies the degree of neurological improvement or deterioration followed by acute stroke. We aimed to investigate the association between blood biomarkers and ΔmRS to capture mechanisms under neurological instability in acute ischemic stroke.Methods: Data were obtained from a nationwide, prospective registry study. Patients with acute ischemic stroke and blood samples taken within 24 h after admission were included in this study. Neurological deterioration at 3 months was defined as ΔmRS3m-discharge ≥1 (mRS3m-mRSdischarge=ΔmRS3m-discharge). Associations between blood biomarkers and neurological deterioration were assessed by odds ratios (ORs) and their 95% confidence intervals (CIs) calculated per standard deviation (SD) as well as quartiles in a multiple logistic regression model.Findings: A total of 6931 patients were enrolled, and 1026 (14·8%) patients experienced neurological deterioration 3 months after stroke. hs-CRP (OR 95%[CI] 1·12 [1·07-1·19], per SD (26·6 mg/L) increase), IL-6 (1·17 [1·10-1·25], per 4·6 pg/mL increase) and YKL-40 (1·08 [1·01-1·16], per 64760·3 ng/mL increase) were strongly associated with neurological deterioration at 3 months (all P for trend <0·05). Compared with the bottom level, the risk of neurological deterioration was significantly higher for patients with top levels of hs-CRP (1·37 [1·12-1·67], IL-6 (1·43 [1·16-1·76]) and YKL-40 (1·31 [1·06-1·62]). The three inflammation biomarkers have similar relationships with neurological deterioration at 6 months and 12 months after acute ischemic stroke.Interpretation: The levels of hs-CRP, IL-6, and YKL-40 were significantly associated with neurological deterioration in the subacute and chronic phases of ischemic stroke, indicating that inflammation may be a mechanism underlying neurological instability.Funding Information: The Beijing Natural Science Foundation, the National Natural Science Foundation of China, and the Ministry of Science and Technology of the People’s Republic of China.Declaration of Interests: All authors declare that they have no conflicts of interest.Ethics Approval Statement: The protocol of the CNSRIII was approved by the Ethics Committee of Beijing Tiantan Hospital and all participating centers.