Serum Soluble Low-Density Lipoprotein Receptor-Related Protein 1 (sLRP1) is Negatively Associated With Functional Outcome Improvement From 3 to 12 Months After Acute Ischemic Stroke

Aims Serum soluble low-density lipoprotein receptor-related protein 1 (sLRP1) has been implicated in the severity of ischemia-reperfusion injury in experimental stroke models. Its potential prognostic value in ischemic stroke recovery warrants further investigation. This study aims to explore the association between serum sLRP1 levels and functional outcome improvement from 3 to 12 months following acute ischemic stroke (AIS). Methods We included patients hospitalized for AIS within 24 hours of symptom onset. Serum sLRP1 levels at admission were analyzed for their association with functional outcome improvement, defined as a ≥1-point decrease in the modified Rankin Scale (mRS) score between 3 and 12 months. Multivariate binary logistic regression was employed to adjust for potential confounders. Improvements in predictive performance by including sLRP1 were assessed using the net reclassification index (NRI) and integrated discrimination improvement (IDI). Results A total of 171 patients were enrolled (median age: 65 years; 64.9% male). Functional outcome improvement was observed in 53 patients (31.0%). After adjusting for confounding factors, patients in the second and third tertiles of sLRP1 had significantly lower odds of functional outcome improvement compared to those in the lowest tertile (Tertile 2, odds ratio [OR] 0.19, 95% confidence interval [CI]: 0.08-0.49, P = .001; Tertile 3, OR 0.10, 95% CI: 0.03-0.27, P < .001). Incorporating sLRP1 into predictive models alongside conventional factors significantly enhanced reclassification accuracy (NRI = 46%, P = .004; IDI = 4%, P = .014). Conclusions Lower serum sLRP1 levels at admission are independently associated with functional outcome improvement after AIS. These findings suggest that modulating sLRP1 may represent a promising therapeutic strategy to enhance recovery in stroke patients.