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Qi Y, Shang X, Han T, Han N, Jiang Z, Yan H, Yue S, Sun Q, Liu L, Cui C. Serum cystatin C and stroke risk: a national cohort and Mendelian randomization study. Front Endocrinol (Lausanne) 2024; 15:1355948. [PMID: 38681764 PMCID: PMC11045987 DOI: 10.3389/fendo.2024.1355948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/20/2024] [Indexed: 05/01/2024] Open
Abstract
Purpose The debate over the causal and longitudinal association between cystatin C and stroke in older adults persists. Our aim was to assess the link between cystatin C levels, both measured and genetically predicted, and stroke risk. Methods This study employed a retrospective cohort design using samples of the China Health and Retirement Longitudinal Study (CHARLS), which is a nationally representative cohort recruiting individuals aged 45 years or above. A multivariate logistic model and the two-sample Mendelian randomization framework were used to investigate the longitudinal and genetically predicted effect of serum cystatin C on stroke. Results The study population had a mean age of 59.6 (SD ±9.5), with 2,996 (46.1%) women. After adjusting for confounding factors, compared to those in the first quartile of cystatin C, those in the last quartile had the greatest risk of stroke incidence [odds ratio (OR), 1.380; 95% confidence interval (CI), 1.046-1.825]. The Mendelian randomization analysis showed that a genetically predicted cystatin C level was positively associated with total stroke (OR by inverse variance-weighted method, 1.114; 95% CI, 1.041-1.192). Conclusions This national cohort study suggests that higher serum cystatin C is associated with an increased risk of total stroke, which is further supported by Mendelian randomization.
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Affiliation(s)
- Yitian Qi
- China-Japan Union Hospital of Jilin University, Jilin University, Changchun, Jilin, China
| | - Xinyun Shang
- China-Japan Union Hospital of Jilin University, Jilin University, Changchun, Jilin, China
| | - Tianjiao Han
- China-Japan Union Hospital of Jilin University, Jilin University, Changchun, Jilin, China
| | - Ning Han
- China-Japan Union Hospital of Jilin University, Jilin University, Changchun, Jilin, China
| | - Ziwei Jiang
- China-Japan Union Hospital of Jilin University, Jilin University, Changchun, Jilin, China
| | - Han Yan
- China-Japan Union Hospital of Jilin University, Jilin University, Changchun, Jilin, China
| | - Siqi Yue
- China-Japan Union Hospital of Jilin University, Jilin University, Changchun, Jilin, China
| | - Qichao Sun
- The First Bethune Hospital of Jilin University, Jilin University, Changchun, Jilin, China
| | - Lin Liu
- China-Japan Union Hospital of Jilin University, Jilin University, Changchun, Jilin, China
| | - Cancan Cui
- China-Japan Union Hospital of Jilin University, Jilin University, Changchun, Jilin, China
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Ding Y, Liu L, Chen Z, Li H, Pan Y, Wang J, Meng X, Lin J, Jing J, Xie X, Xiang X, Wang Y. Serum Cystatin C Predicts Stroke Clinical Outcomes at 1 Year Independent of Renal Function. Front Neurol 2021; 12:676872. [PMID: 34456843 PMCID: PMC8385197 DOI: 10.3389/fneur.2021.676872] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 06/25/2021] [Indexed: 11/17/2022] Open
Abstract
Objective: Serum cystatin C (CysC) is a sensitive marker of renal function to predict cardiovascular diseases. We aimed to investigate the predictive value of CysC for clinical outcomes independent of renal function in patients with acute ischemic stroke (AIS). Methods: We measured serum CysC levels in 10,256 AIS patients from Third China National Stroke Registry (CNSR-III). The primary outcome was a combination of all-cause mortality and major disability (modified Rankin scale score, 3–6). Secondary outcomes included stroke recurrence and combined vascular events at 1 year. Outcomes were analyzed using logistic regression and Cox proportional hazards models, respectively. Results: The median CysC of included patients was 0.95 mg/l (interquartile range, 0.83–1.10 mg/l). A U-shaped association was observed between CysC and primary outcome (all-cause mortality or major disability) [quartile (Q)1 vs. Q2: adjusted odds ratio (aOR) 1.29, 95% CI 1.06–1.58, p = 0.012; Q3 vs. Q2: aOR 1.12, 95% CI 0.93–1.35, p = 0.242; Q4 vs. Q2: aOR 1.35, 95% CI 1.10–1.65, p = 0.004]. A similar trend also existed in “preserved renal function” patients. Adding CysC to a model containing conventional risk factors improved the model performance with integrated discrimination improvement (IDI) of 0.13% (p = 0.016) and net reclassification index (NRI) of 13.10% (p <0.001) for primary outcome. No significant association was observed for stroke recurrence or combined vascular event rate in different CysC quartiles. Conclusions: CysC showed a U-shaped correlation with 1-year stroke clinical outcome, suggesting that serum CysC may not only be a simple candidate marker of renal function.
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Affiliation(s)
- Yarong Ding
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Zimo Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Junfeng Wang
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Jinxi Lin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Xuewei Xie
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Xianglong Xiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
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Abstract
Clinical laboratory tests are a critical component of the continuum of care. We evaluate the genetic basis of 35 blood and urine laboratory measurements in the UK Biobank (n = 363,228 individuals). We identify 1,857 loci associated with at least one trait, containing 3,374 fine-mapped associations and additional sets of large-effect (>0.1 s.d.) protein-altering, human leukocyte antigen (HLA) and copy number variant (CNV) associations. Through Mendelian randomization (MR) analysis, we discover 51 causal relationships, including previously known agonistic effects of urate on gout and cystatin C on stroke. Finally, we develop polygenic risk scores (PRSs) for each biomarker and build 'multi-PRS' models for diseases using 35 PRSs simultaneously, which improved chronic kidney disease, type 2 diabetes, gout and alcoholic cirrhosis genetic risk stratification in an independent dataset (FinnGen; n = 135,500) relative to single-disease PRSs. Together, our results delineate the genetic basis of biomarkers and their causal influences on diseases and improve genetic risk stratification for common diseases.
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Shi J, Zhang C, Cao Y, Qu X, Liu H, You S. Prognostic Value of Cystatin C in Acute Ischemic Stroke Patients with Intravenous Thrombolysis. Curr Neurovasc Res 2020; 16:301-309. [PMID: 31490754 DOI: 10.2174/1567202616666190906110204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/15/2019] [Accepted: 07/22/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Less is known about the prognostic value of serum cystatin C in acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT). The aim of the present study was to examine the association between serum cystatin C levels and prognosis of AIS patients after IVT. METHODS Serum cystatin C was measured within 24 hours after recombinant tissue plasminogen activator (rt-PA) treatment in 280 consecutively recruited patients with AIS. The main outcomes included combination of death and major disability, death, major disability (modified Rankin Scale score 3-5) and vascular events at 3-month follow-up. RESULTS During the 3-month follow-up, 94 patients (33.6%) experienced death or major disability (28 deaths and 66 major disability) and 49 patients (17.5%) experienced vascular events. After multivariate adjustment, serum cystatin C was significantly associated with an increased risk of the combined outcome of death and major disability (OR=4.51, P = 0.006). Adding serum cystatin C quartiles to a model containing conventional risk factors improved the predictive power for the combined outcome of death and major disability (continuous net reclassification index 43.88%, P < 0.001; categorical net reclassification index 9.15%, P = 0.013; integrated discrimination improvement 2.31%, P = 0.025). Similar phenomena were also observed in major disability and vascular events. CONCLUSION Higher levels of serum cystatin C in AIS patients after IVT were independently associated with increased risks of poor functional outcomes and vascular events, especially combining conventional risk factors, suggesting that serum cystatin C might improve risk prediction for poor prognosis in AIS patients receiving rt-PA treatment.
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Affiliation(s)
- Jijun Shi
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Chunyuan Zhang
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yongjun Cao
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xinyuan Qu
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Huihui Liu
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Shoujiang You
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
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Zaki MA, Atty SA, Aboul fotouh AM, Wahdan NS. Cystatin C as a predictor for carotid artery steno-occlusive disease in non-cardioembolic ischemic stroke. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2019. [DOI: 10.1186/s41983-019-0096-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Wang Y, Zhang Y, Ma Q, Wang C, Xu Y, Sun H, Ma Y. Determination of Clinical Cut-Off Values for Serum Cystatin C Levels to Predict Ischemic Stroke Risk. J Stroke Cerebrovasc Dis 2019; 28:104345. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.104345] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 07/29/2019] [Accepted: 08/09/2019] [Indexed: 12/15/2022] Open
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7
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Clinical Usefulness of the Serum Cystatin C Levels in Patients with Transient Ischemic Attack. Neurotox Res 2019; 36:645-652. [DOI: 10.1007/s12640-019-00082-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/31/2019] [Accepted: 06/21/2019] [Indexed: 12/09/2022]
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8
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Wang Y, Li W, Yang J, Zhang M, Tian C, Ma M, Zhang Q. Association Between Cystatin C and the Risk of Ischemic Stroke: a Systematic Review and Meta-analysis. J Mol Neurosci 2019; 69:444-449. [PMID: 31313057 DOI: 10.1007/s12031-019-01373-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 06/27/2019] [Indexed: 01/11/2023]
Abstract
Ischemic stroke is a disease that affects people's health and quality of life. Cystatin C has been found as a new biomarker of cardiovascular disease. We performed this meta-analysis to assess the relationship between cystatin C and the risk of ischemic stroke. The studies on looking at the association between cystatin C and ischemic stroke were identified from inception to November 18, 2018. We performed a random-effects meta-analysis using mean difference. Nine studies with a total of 3773 ischemic stroke patients were included into the meta-analysis. Our results showed that patients with ischemic stroke had significantly higher serum cystatin C concentrations compared with the participants without ischemic stroke (pooled mean difference, 0.11; 95% confidence interval (CI), 0.00-0.22; P = 0.04), in particular acute ischemic stroke and subclinical cerebral infarction (mean difference, 0.23; 95% CI, 0.11-0.36; P = 0.0003 and mean difference, 0.07; 95% CI, 0.05-0.09; P < 0.00001, respectively). Cystatin C was associated with ischemic stroke, and it could be considered a predictor for the risk of ischemic stroke, especially in acute ischemic stroke and subclinical cerebral infarction.
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Affiliation(s)
- Yan Wang
- Xi'an Medical University, No 74 Hanguangbei Road, Xi'an, 710068, Shaanxi, China
| | - Wei Li
- Department of Neurology, Shaanxi Provincial People's Hospital, No 256 Youyixi Road, Xi'an, 710068, Shaanxi, China.
| | - Jun Yang
- Department of Neurology, Shaanxi Provincial People's Hospital, No 256 Youyixi Road, Xi'an, 710068, Shaanxi, China
| | - Mijuan Zhang
- Xi'an Medical University, No 74 Hanguangbei Road, Xi'an, 710068, Shaanxi, China.,Department of Neurology, Shaanxi Provincial People's Hospital, No 256 Youyixi Road, Xi'an, 710068, Shaanxi, China
| | - Chun'e Tian
- Xi'an Medical University, No 74 Hanguangbei Road, Xi'an, 710068, Shaanxi, China.,Department of Neurology, Shaanxi Provincial People's Hospital, No 256 Youyixi Road, Xi'an, 710068, Shaanxi, China
| | - Minjiang Ma
- Xi'an Medical University, No 74 Hanguangbei Road, Xi'an, 710068, Shaanxi, China.,Department of Neurology, Shaanxi Provincial People's Hospital, No 256 Youyixi Road, Xi'an, 710068, Shaanxi, China
| | - Qian Zhang
- Xi'an Medical University, No 74 Hanguangbei Road, Xi'an, 710068, Shaanxi, China
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Song H, Zhou H, Qu Z, Hou J, Chen W, Cai W, Cheng Q, Chuang DY, Chen S, Li S, Li J, Cheng J, Greenlief CM, Lu Y, Simonyi A, Sun GY, Wu C, Cui J, Gu Z. From Analysis of Ischemic Mouse Brain Proteome to Identification of Human Serum Clusterin as a Potential Biomarker for Severity of Acute Ischemic Stroke. Transl Stroke Res 2018; 10:546-556. [PMID: 30465328 DOI: 10.1007/s12975-018-0675-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 11/01/2018] [Accepted: 11/11/2018] [Indexed: 12/22/2022]
Abstract
Ischemic stroke is a devastating neurological disease that can cause permanent brain damage, but to date, few biomarkers are available to reliably assess the severity of injury during acute onset. In this study, quantitative proteomic analysis of ischemic mouse brain detected the increase in expression levels of clusterin (CLU) and cystatin C (CST3). Since CLU is a secretary protein, serum samples (n = 70) were obtained from acute ischemic stroke (AIS) patients within 24 h of stroke onset and together with 70 matched health controls. Analysis of CLU levels indicated significantly higher levels in AIS patients than healthy controls (14.91 ± 4.03 vs. 12.79 ± 2.22 ng/L; P = 0.0004). Analysis of serum CST3 also showed significant increase in AIS patients as compared with healthy controls (0.90 ± 0.19 vs. 0.84 ± 0.12 ng/L; P = 0.0064). The serum values of CLU were also positively correlated with the NIH Stroke Scale (NIHSS) scores, the time interval after stroke onset, as well as major stroke risk factors associated with lipid profile. These data demonstrate that elevated levels of serum CLU and CST3 are independently associated with AIS and may serve as peripheral biomarkers to aid clinical assessment of AIS and its severity. This pilot study thus contributes to progress toward preclinical proteomic screening by using animal models and allows translation of results from bench to bedside.
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Affiliation(s)
- Hailong Song
- Department of Pathology & Anatomical Sciences, University of Missouri, Columbia, MO, 65211, USA.,Center for Botanical Interaction Studies, University of Missouri, Columbia, MO, 65211, USA
| | - Hui Zhou
- Department of Pathology & Anatomical Sciences, University of Missouri, Columbia, MO, 65211, USA.,Center for Botanical Interaction Studies, University of Missouri, Columbia, MO, 65211, USA
| | - Zhe Qu
- Department of Pathology & Anatomical Sciences, University of Missouri, Columbia, MO, 65211, USA.,Center for Botanical Interaction Studies, University of Missouri, Columbia, MO, 65211, USA
| | - Jie Hou
- Center for Botanical Interaction Studies, University of Missouri, Columbia, MO, 65211, USA.,Computer Science, University of Missouri, Columbia, MO, 65211, USA
| | - Weilong Chen
- Department of Neurology, the Second Affiliated Clinical College of Fujian University of Traditional Chinese Medicine, Fuzhou, 350001, China
| | - Weiwu Cai
- Department of Neurology, the Second Affiliated Clinical College of Fujian University of Traditional Chinese Medicine, Fuzhou, 350001, China
| | - Qiong Cheng
- Department of Neurology, Fujian Provincial Hospital, Fuzhou, 350001, China
| | - Dennis Y Chuang
- Department of Pathology & Anatomical Sciences, University of Missouri, Columbia, MO, 65211, USA.,Center for Botanical Interaction Studies, University of Missouri, Columbia, MO, 65211, USA.,Biochemistry, University of Missouri, Columbia, MO, 65211, USA
| | - Shanyan Chen
- Department of Pathology & Anatomical Sciences, University of Missouri, Columbia, MO, 65211, USA.,Center for Botanical Interaction Studies, University of Missouri, Columbia, MO, 65211, USA
| | - Shuwei Li
- Department of Chemistry and Biochemistry, University of Maryland, College Park, MD, 20742, USA
| | - Jilong Li
- Center for Botanical Interaction Studies, University of Missouri, Columbia, MO, 65211, USA.,Computer Science, University of Missouri, Columbia, MO, 65211, USA
| | - Jianlin Cheng
- Center for Botanical Interaction Studies, University of Missouri, Columbia, MO, 65211, USA.,Computer Science, University of Missouri, Columbia, MO, 65211, USA
| | | | - Yuan Lu
- Xiphophorus Genetic Stock Center, Texas State University, San Marcos, TX, 78666, USA
| | - Agnes Simonyi
- Center for Botanical Interaction Studies, University of Missouri, Columbia, MO, 65211, USA.,Biochemistry, University of Missouri, Columbia, MO, 65211, USA
| | - Grace Y Sun
- Department of Pathology & Anatomical Sciences, University of Missouri, Columbia, MO, 65211, USA.,Center for Botanical Interaction Studies, University of Missouri, Columbia, MO, 65211, USA.,Biochemistry, University of Missouri, Columbia, MO, 65211, USA
| | - Chenghan Wu
- Department of Neurology, the Second Affiliated Clinical College of Fujian University of Traditional Chinese Medicine, Fuzhou, 350001, China
| | - Jiankun Cui
- Department of Pathology & Anatomical Sciences, University of Missouri, Columbia, MO, 65211, USA.,Center for Botanical Interaction Studies, University of Missouri, Columbia, MO, 65211, USA
| | - Zezong Gu
- Department of Pathology & Anatomical Sciences, University of Missouri, Columbia, MO, 65211, USA. .,Center for Botanical Interaction Studies, University of Missouri, Columbia, MO, 65211, USA.
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