Background: Manifestations of ischemic stroke vary widely, and serum biomarkers may be useful for stratification of risk of severe stroke. This study evaluated the association of lipoprotein-associated phospholipase A2 (Lp-PLA2) mass and initial severity.
Methods: We employed a retrospective analysis on our hospital-based registry and recruited 488 first-onset ischemic stroke patients admitted within 24 h after onset and with Lp-PLA2 mass measured. Stroke severities evaluated by National Institutes of Health Stroke Scale (NIHSS) were compared between Lp-PLA2 categories dichotomized by median. Multivariate logistic regression was used to detect the independent risk factors of severe stroke (NIHSS ≥ 7) and receiver operator curve (ROC) was constructed to detect the value of addition of Lp-PLA2 to the model of other risk factors for predicting severe stroke.
Results: Of the overall patients, the median admission NIHSS scores was 3 and 28.1% had severe manifestation. Admission NIHSS scores were different between patients of Lp-PLA2 above and under the median (median NIHSS 4 vs. 3, P < 0.001). Lp-PLA2 levels was correlated with admission NIHSS (r = 0.268, P < 0.001). Logistic regression showed Lp-PLA2 category (OR 2.37, 95%CI 1.44-3.90, P < 0.001) and levels per 100 ng/ml (OR 1.69, 95%CI 1.35-2.11, P < 0.001) were both independently associated with severe stroke. Addition of Lp-PLA2 category and levels to other independent risk factors both increased the area under curves (from 0.676 to 0.718 with category and 0.734 with levels).
Conclusion: Lp-PLA2 was independently related to admission severity in ischemic stroke patients, implying a potential predictive value of Lp-PLA2 for severe stroke in prevention.
Keywords: Ischemic stroke; Lipoprotein-associated phospholipase A2; Stroke severity.