14 biomarkers and subsequent disability in patients with stroke recurrence: results from the SPARCL trial

In patients enrolled in the SPARCL trial levels of osteopontin, neopterin, N-terminal fragment of pro-B-type natriuretic peptide (NT-proBNP), myeloperoxidase, monocyte chemoattractant protein-1 (MCP-1), resistin, matrix metalloproteinase-9 (MMP-9), adiponectin, high-sensitive C-reactive Protein (hsCRP), lipoprotein-associated phospholipase-A2 (Lp-PLA2), soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), soluble CD40-ligand (sCD40L) and HDL-Cholesterol (HDL-c) were measured 1-6 months after the qualifying stroke or TIA . We determined whether any of these biomarkers were associated with disability in case of recurrence. Among 463 recurrent strokes, the associations of these biomarkers with the National Institutes of Health-Stroke Scale (NIHSS), Barthel Index, and modified Rankin Score (mRS) measured after 90-days were assessed. Using adjusted logistic regression analysis, biomarker levels were compared between unfavorable versus favorable outcome (NIHSS>2 versus 0-1; Barthel Index <95 versus 95-100; and mRS 2-6 versus 0-1). Higher baseline levels of osteopontin (OR:1.166; CI95%:1.01-1.347, p=0.0367) and neopterin (OR:1.531; CI95%:1.07-2.188, p=0.0195) predicted poorer outcomes after recurrent stroke. For participants with ischemic stroke, higher levels of neopterin (OR:1.488, CI95%:1.022-2.167, p=0.0384) and NT-proBNP, (OR1.399, CI95%:1.035-1.891, p=0.0289) were predictor of unfavorable mRS. Analyses including stroke and TIA showed that lower HDL-c levels were associated with an unfavorable mRS (OR:0.564, CI 95% 0.328-0.971, p=0.0387). Higher levels of osteopontin, neopterin and NT-ProBNP and lower levels of HDL-c after stroke were independently associated with greater disability in case of recurrent stroke.