Serum lipoprotein-associated phospholipase A2 as a promising prognostic biomarker in association with 90-day outcome of acute intracerebral hemorrhage

Correlation and Prognostic Action of SAA, Hcy, and BNP Levels with the Condition of Patients with Spontaneous Intracerebral Hemorrhage

Objective

To explore the correlation of serum amyloid A (SAA), homocysteine (Hcy), and plasma B-type brain natriuretic peptide (BNP) levels in patients with spontaneous intracerebral hemorrhage (SICH) and their predictive value for the status and prognosis of SICH patients.

Methods

82 SICH patients admitted to our hospital from March 2017 to March 2020 were selected. According to the Glasgow coma scale (GCS) score, the patients were divided into GCS > 8 group (n = 44) and the GCS ≤ 8 group (n = 38). Based on the bleeding volume, the patients were divided into the massive bleeding group (>30 ml) (n = 21), the moderate bleeding group (10∼30 ml) (n = 28), and the small bleeding group (<10 ml) (n = 33). Based on the prognostic status of patients after 28 days of admission, they were divided into the survival group (n = 64) and the death group (n = 18). Serum SAA, Hcy, and plasma BNP levels of patients in different groups were compared, and the correlation between serum SAA, Hcy and plasma BNP levels with GCS score, cerebral hemorrhage, and the prognostic value of patients was analyzed.

Results

Serum SAA, Hcy, and plasma BNP levels in patients with GCS ≤ 8 groups were higher than those in GCS > 8 groups (P < 0.05). Serum SAA, Hcy, and plasma BNP levels of patients in the massive bleeding group were higher than those in the moderate and small bleeding groups. Besides, the level of serum SAA, Hcy, and plasma BNP in the moderate bleeding group was higher than that in the small bleeding group (P < 0.05). Serum SAA, Hcy and plasma BNP levels of patients were negatively correlated with GCS scores but positively correlated with bleeding volume (P < 0.05). The levels of serum SAA, Hcy and plasma BNP in dead patients were higher than those in the survival patients (P < 0.05). The combined prediction of serum SAA, Hcy, and plasma BNP for the prognosis of SICH patients was 0.910 (95% CI: 0.984∼0.837), which was higher than the serum SAA, Hcy, and plasma BNP alone predicted AUC 0.679 (95% CI: 0.564∼0.795), 0.720 (95% CI: 0.603∼0.836), and 0.726 (95% CI: 0.616∼0.849).

Conclusion

The levels of serum SAA, Hcy, and plasma BNP have a correlation with the severity and prognosis of patients with SICH, which is a feasible index for judging the prognosis of SICH. The levels of serum SAA, Hcy, and plasma BNP are conducive to timely judgment of the progression and prognosis of SICH patients.

Lp-PLA2 as a biomarker and its possible associations with SARS-CoV-2 infection

Lp-PLA2 is an enzyme encoded by the PLA2G7 gene located at chromosome 6p12-21, which is included in different signal transduction pathways. The potential of serum levels of Lp-PLA2 as a marker of inflammation quantifying cardio-metabolic risk, renal impairment and oxidative stress has been explored in earlier studies. It has also been used in chronic obstructive pulmonary disease, hepatic disease, metabolic conditions and exercise tolerance. Additionally, it shows promising evidence for the assessment of risk for certain cardiovascular conditions in otherwise seemingly healthy individuals. COVID-19 has affected life and the economy globally. The identification of biomarkers to assess the sickness and treatment plan is the need of the hour. This review summarizes the pathophysiological inter-relationship between serum levels of Lp-PLA2 and COVID-19. The authors hypothesize that the estimation of Lp-PLA2 levels may help in the early identification of risk and thus may play a beneficial role in the proactive management of COVID-19.

Prognostic molecular markers for motor recovery in acute hemorrhagic stroke: A systematic review

BACKGROUND AND AIMS

Molecular biomarkers are associated with poor prognosis in ischemic stroke individuals. However, it might not be generalizable to post-acute hemorrhagic stroke since the underlying mechanisms of this brain damage differ from those found in ischemic stroke. The main purpose of this review was to synthesize the potential predictive molecular biomarkers for motor recovery following acute hemorrhagic stroke.

MATERIALS AND METHODS

An electronic search was conducted by 2 independent reviewers in the following databases: PubMed (Medline), EMBASE, Web of Science, and CINAHL. We included studies that addressed the following: collected blood, urine, or cerebrospinal fluid samples within 72 h after hemorrhagic stroke and that reported the prognostic association with functional motor recovery for each molecular biomarker. Screening of titles, abstracts, and full texts and data extraction were undertaken independently by pairs of reviewers.

RESULTS

Twelve thousand, five hundred and sixty-four studies were identified and 218 were considered eligible. Finally, we included 70 studies, with 96 biomarkers analyzed, of which 61 were considered as independent prognostic biomarkers, and 10 presented controversial results.

CONCLUSION

This systematic review shows that motor functional recovery can be predicted by 61 independent prognostic molecular biomarkers assessed in the acute phase after a hemorrhagic stroke.

Clinical Utility of the Serum Level of Lipoprotein-Related Phospholipase A2 in Acute Ischemic Stroke With Cerebral Artery Stenosis

We aimed to study the clinical utility of serum lipoprotein-associated phospholipase A2 (Lp-PLA2) in acute ischemic stroke (AIS) with cerebral artery stenosis (CAS). We included 200 AIS patients and 90 healthy controls in this study. AIS patients were classified into three subgroups depending on the severity of CAS. They were also classified based on the stability of the carotid plaques. Spearman correlation analysis was performed to determine the correlation relationship between the level of Lp-PLA2 and neurologic injury. Binary logistic regression analysis was performed to determine the independent risk factors for AIS. Receiver operating characteristic (ROC) analysis was performed to assess the diagnostic value of Lp-PLA2 for AIS and for the degree of CAS. We found that the serum level of Lp-PLA2 in AIS patients was significantly higher than that in the control group. Lp-PLA2 was further identified as an independent risk factor for AIS (p = 0.001, OR = 1.057). In addition, serum Lp-PLA2 level was the highest in AIS patients with severe CAS or occlusion. Lp-PLA2 level was higher in AIS patients with unstable plaques and in AIS patients with moderate to severe neurological injury. Lp-PLA2 level was positively correlated with National Institutes of Health Stroke Scale (NIHSS) score (r = 0.335, p = 0.001). We found that the optimal cut-off value for Lp-PLA2 level was 123.365 ng/ml, at which the sensitivity and specificity for the diagnosis of ACI were 74.5 and 86.7%, respectively, and the area under ROC curve (AUC) was 0.892. Similarly, the optimal value for Lp-PLA2 level was 136.46 ng/ml, at which the sensitivity and specificity for the diagnosis of the presence of moderate to severe artery stenosis or occlusion were 79.6 and 95.2%, respectively, and the AUC was 0.938. The ROC curve indicated that serum Lp-PLA2 level has an excellent diagnostic value for AIS and severe stenosis. Based on these results we conclude that Lp-PLA2 could be a potential biomarker to complement the current imaging methods in the prediction and diagnosis of AIS. An elevated Lp-PLA2 level is also correlated with carotid plaque instability, severe neurological injury and cerebrovascular stenosis. Future longitudinal studies are needed to determine whether there is a causative relationship between Lp-PLA2 and AIS.

The physiopathology of spontaneous hemorrhagic stroke: a systematic review

Hemorrhagic stroke (HS) is a major cause of death and disability worldwide, despite being less common, it presents more aggressively and leads to more severe sequelae than ischemic stroke. There are two types of HS: Intracerebral Hemorrhage (ICH) and Subarachnoid Hemorrhage (SAH), differing not only in the site of bleeding, but also in the mechanisms responsible for acute and subacute symptoms. This is a systematic review of databases in search of works of the last five years relating to the comprehension of both kinds of HS. Sixty two articles composed the direct findings of the recent literature and were further characterized to construct the pathophysiology in the order of events. The road to the understanding of the spontaneous HS pathophysiology is far from complete. Our findings show specific and individual results relating to the natural history of the disease of ICH and SAH, presenting common and different risk factors, distinct and similar clinical manifestations at onset or later days to weeks, and possible complications for both.

An analysis of the correlation between the human apolipoprotein E gene polymorphism and lipoprotein-associated phospholipase A2

Background

Atherosclerosis is one of the most common cardiovascular and cerebrovascular diseases. This study aimed to explore the correlation between gene polymorphism of human apolipoprotein E (ApoE) and lipoprotein-associated phospholipase A2 (Lp-PLA2).

Methods

A total of 220 patients with atherosclerotic cardiovascular disease who were treated in our hospital from June 2016 to March 2017 were enrolled in this study and assigned as the atherosclerotic cardiovascular disease group and 193 patients who were treated contemporaneously in our hospital but had no atherosclerotic cardiovascular disease were enrolled and assigned as the control group. Gene polymorphism of ApoE was detected by PCR-fluorescent probe technique and the level of Lp-PLA2 was detected by ELISA.

Results

There were a total of 5 genotypes of ApoE in these two groups, which were E2/3, E3/3, E3/4, E2/4, and E4/4. E2/2 was not found in any of the patients. E3/3 made up the majority in both groups. There was no significant difference between the proportion of genotypes and frequencies of alleles in the two groups (P>0.05). There was no difference between LP-PLA2 among the different genotypes in these two groups (P>0.05).

Conclusions

We cannot conclude that ApoE gene polymorphism is related to atherosclerotic cardiovascular and cerebrovascular diseases. And it cannot be concluded that ApoE gene polymorphism is related to Lp-PLA2 level.

Evaluation of lipoprotein-associated phospholipase A2, serum amyloid A, and fibrinogen as diagnostic biomarkers for patients with acute cerebral infarction

Objective

The aim of this study was to explore the clinical values of combined detection of lipoprotein‐associated phospholipase A2 (Lp‐PLA2), serum amyloid A (SAA), and plasma fibrinogen (FIB) in the diagnosis of acute cerebral infarction (ACI).

Methods

A case‐control study including 100 hospitalized patients with ACI and 47 healthy controls was carried out. The level of Lp‐PLA2, SAA, and FIB was detected, respectively, and their clinical values were analyzed. Carotid lesions and neurological impairment were also analyzed in each patient.

Results

The level of Lp‐PLA2, SAA, and FIB in the ACI group was significantly higher than that of the controls, and the three biomarkers showed a significant positive correlation and were considered as risk factors for ACI. The area under the curve (AUC) for Lp‐PLA2, SAA, and FIB was 0.858, 0.743, and 0.672, respectively. When three biomarkers were used in combination, the AUC was 0.879. Compared with the other groups, the levels of three biomarkers in bilateral carotid plaque ACI group were all significantly higher. In addition, the level of Lp‐PLA2 and SAA in ACI patients with severe neurological impairment was also significantly higher than that of the mild‐to‐moderate group.

Conclusion

Lp‐PLA2 combined with SAA and FIB had a high clinical value for rapid diagnosis and prediction of ACI. These biomarkers were also significantly associated with the formation of bilateral carotid atherosclerotic plaques and the severe neurological impairment in ACI patients.