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  • Serum amyloid A predicts poor functional outcome in patients with ischemic stroke receiving endovascular thrombectomy: a case control study

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Vascular neurology
Serum amyloid A predicts poor functional outcome in patients with ischemic stroke receiving endovascular thrombectomy: a case control study
  1. Shin-Joe Yeh1,
  2. Chih-Hao Chen1,
  3. Yen-Heng Lin2,
  4. Li-Kai Tsai1,3,
  5. Chung-Wei Lee2,
  6. Sung-Chun Tang1,
  7. Jiann-Shing Jeng1
  1. 1 Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
  2. 2 Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
  3. 3 Department of Neurology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
  1. Correspondence to Dr. Sung-Chun Tang, Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan; tangneuro{at}gmail.com; Dr. Chung-Wei Lee, Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan; rad.chungweilee{at}gmail.com

Abstract

Background Post-stroke inflammation contributes to poor outcomes, but its impact on patients with stroke receiving endovascular thrombectomy (EVT) remains unknown.

Methods We enrolled adult patients with stroke who received EVT, with blood sampling immediately before (T1) and after EVT (T2), and at 24 hours after EVT (T3). Non-stroke controls and patients with non-EVT stroke were also enrolled. The medical information, image findings and levels of serum amyloid A (SAA) and C-reactive protein (CRP) were analyzed to clarify the association with poor functional outcome (modified Rankin Scale 4–6) at 3 months after stroke.

Results A total of 93 patients with stroke receiving EVT, 51 non-stroke controls, and 64 with non-EVT stroke were enrolled in this study. The SAA and CRP levels at T1 to T3 in patients with stroke receiving EVT were higher compared with those in controls (all p<0.001), and their levels at T3 were significantly higher than those at T1 (both p<0.0001) while similar to those in patients with non-EVT stroke. The SAA levels at the three time points were significantly associated with poor functional outcome (p=0.003 to 0.009). Furthermore, adding SAA level at T3 significantly improved the basic prediction model for 3-month poor functional outcome by receiver operating characteristic (ROC) analysis (areas under ROC curves from 0.803 to 0.878, p=0.03).

Conclusions Our findings demonstrate that plasma levels of SAA at an early stage are significant predictors for poor functional outcomes at 3 months in patients with stroke receiving EVT, indicating the substantial role of systemic inflammation in shaping stroke outcomes following EVT.

  • stroke
  • thrombectomy
  • inflammation

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/neurintsurg-2021-018234

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Contributors S-JY analyzed and interpreted the data and was a major contributor in writing the manuscript. C-HC, L-KT, S-CT, C-WL and J-SJ offered suggestions for analyzing the data and revising the manuscript. Y-HL and C-WL collected the blood samples before and after EVT. The funding of S-CT was a major funding support of this study. All authors read and approved the final manuscript. S-C T serves as the guarantor who accepts full responsibility for the finished work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

    • Funding This work was supported by grants from the National Taiwan University Hospital (NTUH 110-S4981 and 110-S4812).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.