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Barros-Aragão FG, Pinto TP, Carregari VC, Rezende NB, Pinheiro TL, Reis-de-Oliveira G, Cabral-Castro MJ, Queiroz DC, Fonseca PL, Gonçalves AL, de Freitas GR, Sudo FK, Mattos P, Bozza FA, Rodrigues EC, Aguiar RS, Rodrigues RS, Brandão CO, Souza AS, Martins-de-Souza D, De Felice FG, Tovar-Moll F. Changes in neuroinflammatory biomarkers correlate with disease severity and neuroimaging alterations in patients with COVID-19 neurological complications. Brain Behav Immun Health 2024; 39:100805. [PMID: 39022627 PMCID: PMC11253226 DOI: 10.1016/j.bbih.2024.100805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 05/15/2024] [Accepted: 06/10/2024] [Indexed: 07/20/2024] Open
Abstract
COVID-19 induces acute and persistent neurological symptoms in mild and severe cases. Proposed concomitant mechanisms include direct viral infection and strain, coagulopathy, hypoxia, and neuroinflammation. However, underlying molecular alterations associated with multiple neurological outcomes in both mild and severe cases are majorly unexplored. To illuminate possible mechanisms leading to COVID-19 neurological disease, we retrospectively investigated in detail a cohort of 35 COVID-19 mild and severe hospitalized patients presenting neurological alterations subject to clinically indicated cerebrospinal fluid (CSF) sampling. Clinical and neurological investigation, brain imaging, viral sequencing, and cerebrospinal CSF analyses were carried out. We found that COVID-19 patients presented heterogeneous neurological symptoms dissociated from lung burden. Nasal swab viral sequencing revealed a dominant strain at the time of the study, and we could not detect traces of SARS-CoV-2's spike protein in patients' CSF by multiple reaction monitoring analysis. Patients presented ubiquitous systemic hyper-inflammation and broad alterations in CSF proteomics related to inflammation, innate immunity, and hemostasis, irrespective of COVID-19 severity or neuroimaging alterations. Elevated CSF interleukin-6 (IL6) correlated with disease severity (sex-, age-, and comorbidity-adjusted mean Severe 24.5 pg/ml, 95% confidence interval (CI) 9.62-62.23 vs. Mild 3.91 pg/mL CI 1.5-10.3 patients, p = 0.019). CSF tumor necrosis factor-alpha (TNFα) and IL6 levels were higher in patients presenting pronounced neuroimaging alterations compared to those who did not (sex-, age-, and comorbidity-adjusted mean TNFα Pronounced 3.4, CI 2.4-4.4 vs. Non-Pronounced 2.0, CI 1.4-2.5, p = 0.022; IL6 Pronounced 33.11, CI 8.89-123.31 vs Non-Pronounced 6.22, CI 2.9-13.34, p = 0.046). Collectively, our findings put neuroinflammation as a possible driver of COVID-19 acute neurological disease in mild and severe cases.
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Affiliation(s)
- Fernanda G.Q. Barros-Aragão
- D’Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil, 22281-100
- Institute of Medical Biochemistry Leopoldo De Meis (IBqM), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil, 21941-902
- Centre for Neuroscience Studies, Department of Biomedical and Molecular Sciences & Department of Psychiatry, Queen's University, Kingston, Ontario, Canada, K7L 3N6
| | - Talita P. Pinto
- D’Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil, 22281-100
| | - Victor C. Carregari
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil, 13083-862
| | - Nathane B.S. Rezende
- D’Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil, 22281-100
| | - Thaís L. Pinheiro
- D’Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil, 22281-100
- Institute of Medical Biochemistry Leopoldo De Meis (IBqM), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil, 21941-902
| | - Guilherme Reis-de-Oliveira
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil, 13083-862
| | - Mauro J. Cabral-Castro
- Institute of Microbiology Paulo de Goés, UFRJ, Rio de Janeiro, Brazil, 21941-902
- Department of Pathology, Faculty of Medicine, Universidade Federal Fluminense, Niterói, RJ, Brazil, 24210-346
| | - Daniel C. Queiroz
- Department of Genetics, Ecology, and Evolution, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Brazil, 31270-901
| | - Paula L.C. Fonseca
- Department of Genetics, Ecology, and Evolution, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Brazil, 31270-901
| | - Alessandro L. Gonçalves
- Department of Genetics, Ecology, and Evolution, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Brazil, 31270-901
| | | | - Felipe K. Sudo
- D’Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil, 22281-100
| | - Paulo Mattos
- D’Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil, 22281-100
| | - Fernando A. Bozza
- D’Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil, 22281-100
| | - Erika C. Rodrigues
- D’Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil, 22281-100
| | - Renato S. Aguiar
- D’Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil, 22281-100
- Department of Genetics, Ecology, and Evolution, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Brazil, 31270-901
| | - Rosana S. Rodrigues
- D’Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil, 22281-100
| | | | - Andrea S. Souza
- D’Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil, 22281-100
| | - Daniel Martins-de-Souza
- D’Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil, 22281-100
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil, 13083-862
| | - Fernanda G. De Felice
- D’Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil, 22281-100
- Institute of Medical Biochemistry Leopoldo De Meis (IBqM), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil, 21941-902
- Centre for Neuroscience Studies, Department of Biomedical and Molecular Sciences & Department of Psychiatry, Queen's University, Kingston, Ontario, Canada, K7L 3N6
| | - Fernanda Tovar-Moll
- D’Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil, 22281-100
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Sun Y, Han X, Li Z, Qiu Y, Hu Y, Zhang Y, Dai Y, Wei H, Xu Q, Zhou Y. Quantifying neuroinflammation within deep gray matter in small vessel disease using diffusion tensor based free-water imaging: a longitudinal study. Front Aging Neurosci 2024; 16:1361436. [PMID: 39050988 PMCID: PMC11266054 DOI: 10.3389/fnagi.2024.1361436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 06/25/2024] [Indexed: 07/27/2024] Open
Abstract
Purpose Employing free water (FW) imaging, a cutting-edge diffusion MRI technique, we assessed neuroinflammation within deep gray matter (DGM) in small vessel disease (SVD) over 1-2 years. Method One hundred and seventy SVD patients and 21 healthy controls (HCs) underwent MRI scans and neuropsychological evaluations at baseline. These patients were then categorized into two groups: 67 displayed no cognitive impairment (NCI), while 103 exhibited vascular mild cognitive impairment (VaMCI). A follow-up study 1-2 years later included 23 from the NCI group and 28 from the VaMCI group. Calculation of FW values within DGM facilitated both cross-sectional and longitudinal analysis, revealing partial correlations between FW value changes and cognitive function alternations. Results Baseline examinations disclosed significant differences in DGM FW values among the three participant groups. We found increased mean FW values in the left pulvinar (Pul), bilateral lateral nuclei (LN) and bilateral internal medullary lamina of the thalamus in VaMCI participants compared with their NCI counterparts in longitudinal analysis. Notably, negative associations emerged between the FW value changes in the left Pul and the right LN of the thalamus and MoCA score changes in the VaMCI group over 1-2 years. Conclusions These findings support the hypothesis that increased FW value is present at the preclinical stage of SVD and remains persistent during the early course of the disease, potentially acting as the biomarker for the mechanism of underlying cognitive decline in SVD.
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Affiliation(s)
- Yawen Sun
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xu Han
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhenghao Li
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yage Qiu
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Hu
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yuyao Zhang
- School of Information and Science and Technology, ShanghaiTech University, Shanghai, China
| | - Yongming Dai
- School of Biomedical Engineering and State Key Laboratory of Advanced Medical Materials and Devices, ShanghaiTech University, Shanghai, China
| | - Hongjiang Wei
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Qun Xu
- Department of Health Manage Center, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Zhou
- Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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3
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Gao Y, Zong C, Yao Y, Zhao H, Song Y, Zhang K, Yang H, Liu H, Wang Y, Li Y, Yang J, Song B, Xu Y. Elevated Fibrinogen-to-Albumin Ratio Correlates with Incident Stroke in Cerebral Small Vessel Disease. J Inflamm Res 2024; 17:4331-4343. [PMID: 38979435 PMCID: PMC11230119 DOI: 10.2147/jir.s466879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 06/15/2024] [Indexed: 07/10/2024] Open
Abstract
Purpose We aimed to explore the association between fibrinogen-to-albumin ratio (FAR) and the risk of incident stroke (IS) in a cohort of cerebral small vessel disease (CSVD) patients. Patients and Methods Participants were screened from a prospective CSVD database. Clinical data, hematologic measures and imaging findings were collected. The primary outcome was IS during follow-up, with a secondary outcome of composite vascular events (CVE) including IS, myocardial infarction (MI), and vascular deaths. Univariate and multivariate COX proportional risk models, along with competing risk models, were employed to identify factors associated with outcomes. Restricted cubic spline (RCS) and subgroup analyses were conducted to assess the association between FAR and the risk of IS and CVE in CSVD patients. Results In the final analysis of 682 CSVD patients over a median observation period of 34.0 [24.0-53.0] months, there were 33 cases of IS (4.84%, 1.55/100 person-years), 4 incidents of MI (0.59%, 0.19/100 person-years), 15 non-vascular deaths (2.20%, 0.70/100 person-years), and 37 occurrences of CVE (5.43%, 1.74/100 person-years). Multivariate Cox regression analysis revealed a significant positive correlation between elevated FAR and both IS (HR 1.146; 95% CI 1.043-1.259; P=0.004) and CVE (HR 1.156; 95% CI 1.063-1.257; P=0.001) in CSVD patients. Multivariate competing risk model showed the similar results (IS: HR 1.16; 95% CI 1.06-1.27; P=0.001, CVE: HR 1.15; 95% CI 1.05-1.26; P=0.003). RCS analysis indicated a linear relationship between FAR and the risks of both IS (P for non-linearity =0.7016) and CVE (P for non-linearity =0.6475), with an optimal cutoff value of 8.69, particularly in individuals over 60 years of age. Conclusion Elevated FAR demonstrated an independent and linear association with IS and the development of CVE in CSVD patients.
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Affiliation(s)
- Yuan Gao
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Disease, Zhengzhou, Henan, People's Republic of China
- Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, Henan, People's Republic of China
| | - Ce Zong
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Ying Yao
- School of Health and Nursing, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Haixu Zhao
- School of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yuan Song
- School of Health and Nursing, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Ke Zhang
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Hongxun Yang
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Hongbing Liu
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yunchao Wang
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yusheng Li
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Disease, Zhengzhou, Henan, People's Republic of China
- Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, Henan, People's Republic of China
| | - Jing Yang
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Disease, Zhengzhou, Henan, People's Republic of China
- Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, Henan, People's Republic of China
| | - Bo Song
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Disease, Zhengzhou, Henan, People's Republic of China
- Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, Henan, People's Republic of China
| | - Yuming Xu
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
- NHC Key Laboratory of Prevention and Treatment of Cerebrovascular Disease, Zhengzhou, Henan, People's Republic of China
- Henan Key Laboratory of Cerebrovascular Diseases, Zhengzhou, Henan, People's Republic of China
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4
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Debette S, Caro I, Western D, Namba S, Sun N, Kawaguchi S, He Y, Fujita M, Roshchupkin G, D'Aoust T, Duperron MG, Sargurupremraj M, Tsuchida A, Koido M, Ahmadi M, Yang C, Timsina J, Ibanez L, Matsuda K, Suzuki Y, Oda Y, Kanai A, Jandaghi P, Munter HM, Auld D, Astafeva I, Puerta R, Rotter J, Psaty B, Bis J, Longstreth W, Couffinhal T, Garcia-Gonzalez P, Pytel V, Marquié M, Cano A, Boada M, Joliot M, Lathrop M, Le Grand Q, Launer L, Wardlaw J, Heiman M, Ruiz A, Matthews P, Seshadri S, Fornage M, Adams H, Mishra A, Trégouët DA, Okada Y, Kellis M, De Jager P, Tzourio C, Kamatani Y, Matsuda F, Cruchaga C. Proteogenomics in cerebrospinal fluid and plasma reveals new biological fingerprint of cerebral small vessel disease. RESEARCH SQUARE 2024:rs.3.rs-4535534. [PMID: 39011113 PMCID: PMC11247936 DOI: 10.21203/rs.3.rs-4535534/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
Cerebral small vessel disease (cSVD) is a leading cause of stroke and dementia with no specific mechanism-based treatment. We used Mendelian randomization to combine a unique cerebrospinal fluid (CSF) and plasma pQTL resource with the latest European-ancestry GWAS of MRI-markers of cSVD (white matter hyperintensities, perivascular spaces). We describe a new biological fingerprint of 49 protein-cSVD associations, predominantly in the CSF. We implemented a multipronged follow-up, across fluids, platforms, and ancestries (Europeans and East-Asian), including testing associations of direct plasma protein measurements with MRI-cSVD. We highlight 16 proteins robustly associated in both CSF and plasma, with 24/4 proteins identified in CSF/plasma only. cSVD-proteins were enriched in extracellular matrix and immune response pathways, and in genes enriched in microglia and specific microglial states (integration with single-nucleus RNA sequencing). Immune-related proteins were associated with MRI-cSVD already at age twenty. Half of cSVD-proteins were associated with stroke, dementia, or both, and seven cSVD-proteins are targets for known drugs (used for other indications in directions compatible with beneficial therapeutic effects. This first cSVD proteogenomic signature opens new avenues for biomarker and therapeutic developments.
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Affiliation(s)
| | | | - Daniel Western
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Na Sun
- MIT Computer Science and Artificial Intelligence Laboratory; Broad Institute of MIT and Harvard
| | | | - Yunye He
- Graduate School of Frontier Sciences, The University of Tokyo
| | | | | | - Tim D'Aoust
- Bordeaux Population Health, Inserm U1219, University of Bordeaux
| | | | - Murali Sargurupremraj
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, team VINTAGE, UMR 1219, F-33000 Bordeaux, France; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases Unive
| | | | - Masaru Koido
- Graduate School of Frontier Sciences, The University of Tokyo
| | | | | | - Jigyasha Timsina
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Koichi Matsuda
- Department of Computational Biology and Medical Sciences, Graduate school of Frontier Sciences, The University of Tokyo
| | | | - Yoshiya Oda
- Graduate School of Medicine, The University of Tokyo
| | | | | | | | - Dan Auld
- Victor Phillip Dahdaleh Institute of Genomic Medicine, McGill University
| | - Iana Astafeva
- Bordeaux Population Health, Inserm U1219, University of Bordeaux; Institute of Neurodegenerative Diseases
| | | | - Jerome Rotter
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center
| | | | | | | | - Thierry Couffinhal
- University of Bordeaux, The clinical unit of Exploration, Prevention and Care Center for Atherosclerosis (CEPTA), CHUB, Inserm U1034
| | | | - Vanesa Pytel
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya; CIBERNED, Network Center for Biomedical Research in Neurodegenerative Diseases, National Institute of Health Carlos III
| | | | | | | | | | - Mark Lathrop
- Department of Human Genetics, McGill University, 1205 Dr Penfield Avenue, Montreal, QC, H3A 1B1, Canada
| | - Quentin Le Grand
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219
| | - Lenore Launer
- National Institute on Aging, National Institutes of Health
| | | | | | - Agustin Ruiz
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, University of Texas Health Sciences Center; Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya;CIBERN
| | - Paul Matthews
- UK Dementia Research Institute Centre at Imperial College London
| | | | - Myriam Fornage
- 1. Institute of Molecular Medicine, McGovern Medical School, The University of Texas Health Science Center 2. Human Genetics Center, Department of Epidemiology, School of Public Health
| | - Hieab Adams
- Department of Human Genetics, Radboud University Medical Center; Latin American Brain Health (BrainLat), Universidad Adolfo Ibáñez
| | | | | | - Yukinori Okada
- Department of Genome Informatics, Graduate School of Medicine, The Univ. of Tokyo; Department of Statistical Genetics, Osaka Univ. Graduate School of Medicine; Laboratory for Systems Genetic, RIKEN
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5
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McCabe JJ, Walsh C, Gorey S, Harris K, Hervella P, Iglesias-Rey R, Jern C, Li L, Miyamoto N, Montaner J, Pedersen A, Purroy FF, Rothwell PM, Sudlow CL, Ueno Y, Vicente-Pascual M, Whiteley WN, Woodward M, Kelly PJ. C-Reactive Protein, Interleukin-6, and Vascular Recurrence According to Stroke Subtype: An Individual Participant Data Meta-Analysis. Neurology 2024; 102:e208016. [PMID: 38165328 DOI: 10.1212/wnl.0000000000208016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/26/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Anti-inflammatory therapies reduce major adverse cardiovascular events (MACE) in coronary artery disease but remain unproven after stroke. Establishing the subtype-specific association between inflammatory markers and recurrence risk is essential for optimal selection of patients in randomized trials (RCTs) of anti-inflammatory therapies for secondary stroke prevention. METHODS Using individual participant data (IPD) identified from a systematic review, we analyzed the association between high-sensitivity C-reactive protein, interleukin-6 (IL-6), and vascular recurrence after ischemic stroke or transient ischemic attack. The prespecified coprimary end points were (1) any recurrent MACE (first major coronary event, recurrent stroke, or vascular death) and (2) any recurrent stroke (ischemic, hemorrhagic, or unspecified) after sample measurement. Analyses were performed stratified by stroke mechanism, per quarter and per biomarker unit increase after loge transformation. We then did study-level meta-analysis with comparable published studies not providing IPD. Preferred Reporting Items for Systematic Review and Meta-Analyses IPD guidelines were followed. RESULTS IPD was obtained from 10 studies (8,420 patients). After adjustment for vascular risk factors and statins/antithrombotic therapy, IL-6 was associated with recurrent MACE in stroke caused by large artery atherosclerosis (LAA) (risk ratio [RR] 2.30, 95% CI 1.21-4.36, p = 0.01), stroke of undetermined cause (UND) (RR 1.78, 1.19-2.66, p = 0.005), and small vessel occlusion (SVO) (RR 1.71, 0.99-2.96, p = 0.053) (quarter 4 [Q4] vs quarter 1 [Q1]). No association was observed for stroke due to cardioembolism or other determined cause. Similar results were seen for recurrent stroke and when analyzed per loge unit increase for MACE (LAA, RR 1.26 [1.06-1.50], p = 0.009; SVO, RR 1.22 [1.01-1.47], p = 0.04; UND, RR 1.18 [1.04-1.34], p = 0.01). High-sensitivity CRP was associated with recurrent MACE in UND stroke only (Q4 vs Q1 RR 1.45 [1.04-2.03], p = 0.03). Findings were consistent on study-level meta-analysis of the IPD results with 2 other comparable studies (20,136 patients). DISCUSSION Our data provide new evidence for the selection of patients in future RCTs of anti-inflammatory therapy in stroke due to large artery atherosclerosis, small vessel occlusion, and undetermined etiology according to inflammatory marker profile.
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Affiliation(s)
- John J McCabe
- From the Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI) (J.J.M., C.W., S.G., P.J.K.), Dublin; School of Medicine (J.J.M., S.G., P.J.K.), University College Dublin (UCD); Stroke Service (J.J.M., S.G.), Department of Geriatric Medicine and Department of Neurology (P.J.K.), Mater Misericordiae University Hospital, Dublin; Health Research Institute and Mathematics Applications Consortium for Science and Industry (MACSI) (C.W.), Department of Mathematics and Statistics, University of Limerick, Ireland; George Institute for Global Health (K.H.), University of New South Wales, Sydney, Australia; Neuroimaging and Biotechnology Laboratory (NOBEL) (P.H., R.I.-R.), Clinical Neuroscience Research Laboratory, Health Research Institute of Santiago de Compostela, Spain; Department of Laboratory Medicine (C.J., A.P.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg; Department of Clinical Genetics and Genomics (C.J., A.P.), Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Wolfson Centre for the Prevention of Stroke and Dementia (L.L., P.M.R.) and Nuffield Department of Population Health (W.N.W.), University of Oxford, United Kingdom; Department of Neurology (N.M., Y.U.), Juntendo University School of Medicine, Tokyo, Japan; Department of Neurology (J.M.), Hospital Universitari Vall d'Hebron, Barcelona; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Neurology; Virgen Macarena Hospital (J.M.), Neurology, Sevilla; Neurovascular Research Laboratory (J.M.), Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona; Department of Neurology (F.F.P., M.V.-P.), Hospital Universitari Arnau de Vilanova; Department of Clinical Neurosciences (F.F.P., M.V.-P.), Institut Reserca Biomèdica Lleida, University of Lleida, Spain; Centre for Medical Informatics (C.L.S., W.N.W.), Usher Institute of Population Health Sciences and Informatics; Centre for Clinical Brain Sciences (C.L.S.), University of Edinburgh; and George Institute for Global Health (M.W.), Imperial College London, United Kingdom
| | - Cathal Walsh
- From the Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI) (J.J.M., C.W., S.G., P.J.K.), Dublin; School of Medicine (J.J.M., S.G., P.J.K.), University College Dublin (UCD); Stroke Service (J.J.M., S.G.), Department of Geriatric Medicine and Department of Neurology (P.J.K.), Mater Misericordiae University Hospital, Dublin; Health Research Institute and Mathematics Applications Consortium for Science and Industry (MACSI) (C.W.), Department of Mathematics and Statistics, University of Limerick, Ireland; George Institute for Global Health (K.H.), University of New South Wales, Sydney, Australia; Neuroimaging and Biotechnology Laboratory (NOBEL) (P.H., R.I.-R.), Clinical Neuroscience Research Laboratory, Health Research Institute of Santiago de Compostela, Spain; Department of Laboratory Medicine (C.J., A.P.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg; Department of Clinical Genetics and Genomics (C.J., A.P.), Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Wolfson Centre for the Prevention of Stroke and Dementia (L.L., P.M.R.) and Nuffield Department of Population Health (W.N.W.), University of Oxford, United Kingdom; Department of Neurology (N.M., Y.U.), Juntendo University School of Medicine, Tokyo, Japan; Department of Neurology (J.M.), Hospital Universitari Vall d'Hebron, Barcelona; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Neurology; Virgen Macarena Hospital (J.M.), Neurology, Sevilla; Neurovascular Research Laboratory (J.M.), Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona; Department of Neurology (F.F.P., M.V.-P.), Hospital Universitari Arnau de Vilanova; Department of Clinical Neurosciences (F.F.P., M.V.-P.), Institut Reserca Biomèdica Lleida, University of Lleida, Spain; Centre for Medical Informatics (C.L.S., W.N.W.), Usher Institute of Population Health Sciences and Informatics; Centre for Clinical Brain Sciences (C.L.S.), University of Edinburgh; and George Institute for Global Health (M.W.), Imperial College London, United Kingdom
| | - Sarah Gorey
- From the Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI) (J.J.M., C.W., S.G., P.J.K.), Dublin; School of Medicine (J.J.M., S.G., P.J.K.), University College Dublin (UCD); Stroke Service (J.J.M., S.G.), Department of Geriatric Medicine and Department of Neurology (P.J.K.), Mater Misericordiae University Hospital, Dublin; Health Research Institute and Mathematics Applications Consortium for Science and Industry (MACSI) (C.W.), Department of Mathematics and Statistics, University of Limerick, Ireland; George Institute for Global Health (K.H.), University of New South Wales, Sydney, Australia; Neuroimaging and Biotechnology Laboratory (NOBEL) (P.H., R.I.-R.), Clinical Neuroscience Research Laboratory, Health Research Institute of Santiago de Compostela, Spain; Department of Laboratory Medicine (C.J., A.P.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg; Department of Clinical Genetics and Genomics (C.J., A.P.), Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Wolfson Centre for the Prevention of Stroke and Dementia (L.L., P.M.R.) and Nuffield Department of Population Health (W.N.W.), University of Oxford, United Kingdom; Department of Neurology (N.M., Y.U.), Juntendo University School of Medicine, Tokyo, Japan; Department of Neurology (J.M.), Hospital Universitari Vall d'Hebron, Barcelona; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Neurology; Virgen Macarena Hospital (J.M.), Neurology, Sevilla; Neurovascular Research Laboratory (J.M.), Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona; Department of Neurology (F.F.P., M.V.-P.), Hospital Universitari Arnau de Vilanova; Department of Clinical Neurosciences (F.F.P., M.V.-P.), Institut Reserca Biomèdica Lleida, University of Lleida, Spain; Centre for Medical Informatics (C.L.S., W.N.W.), Usher Institute of Population Health Sciences and Informatics; Centre for Clinical Brain Sciences (C.L.S.), University of Edinburgh; and George Institute for Global Health (M.W.), Imperial College London, United Kingdom
| | - Katie Harris
- From the Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI) (J.J.M., C.W., S.G., P.J.K.), Dublin; School of Medicine (J.J.M., S.G., P.J.K.), University College Dublin (UCD); Stroke Service (J.J.M., S.G.), Department of Geriatric Medicine and Department of Neurology (P.J.K.), Mater Misericordiae University Hospital, Dublin; Health Research Institute and Mathematics Applications Consortium for Science and Industry (MACSI) (C.W.), Department of Mathematics and Statistics, University of Limerick, Ireland; George Institute for Global Health (K.H.), University of New South Wales, Sydney, Australia; Neuroimaging and Biotechnology Laboratory (NOBEL) (P.H., R.I.-R.), Clinical Neuroscience Research Laboratory, Health Research Institute of Santiago de Compostela, Spain; Department of Laboratory Medicine (C.J., A.P.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg; Department of Clinical Genetics and Genomics (C.J., A.P.), Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Wolfson Centre for the Prevention of Stroke and Dementia (L.L., P.M.R.) and Nuffield Department of Population Health (W.N.W.), University of Oxford, United Kingdom; Department of Neurology (N.M., Y.U.), Juntendo University School of Medicine, Tokyo, Japan; Department of Neurology (J.M.), Hospital Universitari Vall d'Hebron, Barcelona; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Neurology; Virgen Macarena Hospital (J.M.), Neurology, Sevilla; Neurovascular Research Laboratory (J.M.), Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona; Department of Neurology (F.F.P., M.V.-P.), Hospital Universitari Arnau de Vilanova; Department of Clinical Neurosciences (F.F.P., M.V.-P.), Institut Reserca Biomèdica Lleida, University of Lleida, Spain; Centre for Medical Informatics (C.L.S., W.N.W.), Usher Institute of Population Health Sciences and Informatics; Centre for Clinical Brain Sciences (C.L.S.), University of Edinburgh; and George Institute for Global Health (M.W.), Imperial College London, United Kingdom
| | - Pablo Hervella
- From the Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI) (J.J.M., C.W., S.G., P.J.K.), Dublin; School of Medicine (J.J.M., S.G., P.J.K.), University College Dublin (UCD); Stroke Service (J.J.M., S.G.), Department of Geriatric Medicine and Department of Neurology (P.J.K.), Mater Misericordiae University Hospital, Dublin; Health Research Institute and Mathematics Applications Consortium for Science and Industry (MACSI) (C.W.), Department of Mathematics and Statistics, University of Limerick, Ireland; George Institute for Global Health (K.H.), University of New South Wales, Sydney, Australia; Neuroimaging and Biotechnology Laboratory (NOBEL) (P.H., R.I.-R.), Clinical Neuroscience Research Laboratory, Health Research Institute of Santiago de Compostela, Spain; Department of Laboratory Medicine (C.J., A.P.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg; Department of Clinical Genetics and Genomics (C.J., A.P.), Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Wolfson Centre for the Prevention of Stroke and Dementia (L.L., P.M.R.) and Nuffield Department of Population Health (W.N.W.), University of Oxford, United Kingdom; Department of Neurology (N.M., Y.U.), Juntendo University School of Medicine, Tokyo, Japan; Department of Neurology (J.M.), Hospital Universitari Vall d'Hebron, Barcelona; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Neurology; Virgen Macarena Hospital (J.M.), Neurology, Sevilla; Neurovascular Research Laboratory (J.M.), Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona; Department of Neurology (F.F.P., M.V.-P.), Hospital Universitari Arnau de Vilanova; Department of Clinical Neurosciences (F.F.P., M.V.-P.), Institut Reserca Biomèdica Lleida, University of Lleida, Spain; Centre for Medical Informatics (C.L.S., W.N.W.), Usher Institute of Population Health Sciences and Informatics; Centre for Clinical Brain Sciences (C.L.S.), University of Edinburgh; and George Institute for Global Health (M.W.), Imperial College London, United Kingdom
| | - Ramon Iglesias-Rey
- From the Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI) (J.J.M., C.W., S.G., P.J.K.), Dublin; School of Medicine (J.J.M., S.G., P.J.K.), University College Dublin (UCD); Stroke Service (J.J.M., S.G.), Department of Geriatric Medicine and Department of Neurology (P.J.K.), Mater Misericordiae University Hospital, Dublin; Health Research Institute and Mathematics Applications Consortium for Science and Industry (MACSI) (C.W.), Department of Mathematics and Statistics, University of Limerick, Ireland; George Institute for Global Health (K.H.), University of New South Wales, Sydney, Australia; Neuroimaging and Biotechnology Laboratory (NOBEL) (P.H., R.I.-R.), Clinical Neuroscience Research Laboratory, Health Research Institute of Santiago de Compostela, Spain; Department of Laboratory Medicine (C.J., A.P.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg; Department of Clinical Genetics and Genomics (C.J., A.P.), Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Wolfson Centre for the Prevention of Stroke and Dementia (L.L., P.M.R.) and Nuffield Department of Population Health (W.N.W.), University of Oxford, United Kingdom; Department of Neurology (N.M., Y.U.), Juntendo University School of Medicine, Tokyo, Japan; Department of Neurology (J.M.), Hospital Universitari Vall d'Hebron, Barcelona; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Neurology; Virgen Macarena Hospital (J.M.), Neurology, Sevilla; Neurovascular Research Laboratory (J.M.), Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona; Department of Neurology (F.F.P., M.V.-P.), Hospital Universitari Arnau de Vilanova; Department of Clinical Neurosciences (F.F.P., M.V.-P.), Institut Reserca Biomèdica Lleida, University of Lleida, Spain; Centre for Medical Informatics (C.L.S., W.N.W.), Usher Institute of Population Health Sciences and Informatics; Centre for Clinical Brain Sciences (C.L.S.), University of Edinburgh; and George Institute for Global Health (M.W.), Imperial College London, United Kingdom
| | - Christina Jern
- From the Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI) (J.J.M., C.W., S.G., P.J.K.), Dublin; School of Medicine (J.J.M., S.G., P.J.K.), University College Dublin (UCD); Stroke Service (J.J.M., S.G.), Department of Geriatric Medicine and Department of Neurology (P.J.K.), Mater Misericordiae University Hospital, Dublin; Health Research Institute and Mathematics Applications Consortium for Science and Industry (MACSI) (C.W.), Department of Mathematics and Statistics, University of Limerick, Ireland; George Institute for Global Health (K.H.), University of New South Wales, Sydney, Australia; Neuroimaging and Biotechnology Laboratory (NOBEL) (P.H., R.I.-R.), Clinical Neuroscience Research Laboratory, Health Research Institute of Santiago de Compostela, Spain; Department of Laboratory Medicine (C.J., A.P.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg; Department of Clinical Genetics and Genomics (C.J., A.P.), Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Wolfson Centre for the Prevention of Stroke and Dementia (L.L., P.M.R.) and Nuffield Department of Population Health (W.N.W.), University of Oxford, United Kingdom; Department of Neurology (N.M., Y.U.), Juntendo University School of Medicine, Tokyo, Japan; Department of Neurology (J.M.), Hospital Universitari Vall d'Hebron, Barcelona; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Neurology; Virgen Macarena Hospital (J.M.), Neurology, Sevilla; Neurovascular Research Laboratory (J.M.), Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona; Department of Neurology (F.F.P., M.V.-P.), Hospital Universitari Arnau de Vilanova; Department of Clinical Neurosciences (F.F.P., M.V.-P.), Institut Reserca Biomèdica Lleida, University of Lleida, Spain; Centre for Medical Informatics (C.L.S., W.N.W.), Usher Institute of Population Health Sciences and Informatics; Centre for Clinical Brain Sciences (C.L.S.), University of Edinburgh; and George Institute for Global Health (M.W.), Imperial College London, United Kingdom
| | - Linxin Li
- From the Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI) (J.J.M., C.W., S.G., P.J.K.), Dublin; School of Medicine (J.J.M., S.G., P.J.K.), University College Dublin (UCD); Stroke Service (J.J.M., S.G.), Department of Geriatric Medicine and Department of Neurology (P.J.K.), Mater Misericordiae University Hospital, Dublin; Health Research Institute and Mathematics Applications Consortium for Science and Industry (MACSI) (C.W.), Department of Mathematics and Statistics, University of Limerick, Ireland; George Institute for Global Health (K.H.), University of New South Wales, Sydney, Australia; Neuroimaging and Biotechnology Laboratory (NOBEL) (P.H., R.I.-R.), Clinical Neuroscience Research Laboratory, Health Research Institute of Santiago de Compostela, Spain; Department of Laboratory Medicine (C.J., A.P.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg; Department of Clinical Genetics and Genomics (C.J., A.P.), Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Wolfson Centre for the Prevention of Stroke and Dementia (L.L., P.M.R.) and Nuffield Department of Population Health (W.N.W.), University of Oxford, United Kingdom; Department of Neurology (N.M., Y.U.), Juntendo University School of Medicine, Tokyo, Japan; Department of Neurology (J.M.), Hospital Universitari Vall d'Hebron, Barcelona; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Neurology; Virgen Macarena Hospital (J.M.), Neurology, Sevilla; Neurovascular Research Laboratory (J.M.), Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona; Department of Neurology (F.F.P., M.V.-P.), Hospital Universitari Arnau de Vilanova; Department of Clinical Neurosciences (F.F.P., M.V.-P.), Institut Reserca Biomèdica Lleida, University of Lleida, Spain; Centre for Medical Informatics (C.L.S., W.N.W.), Usher Institute of Population Health Sciences and Informatics; Centre for Clinical Brain Sciences (C.L.S.), University of Edinburgh; and George Institute for Global Health (M.W.), Imperial College London, United Kingdom
| | - Nobukazu Miyamoto
- From the Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI) (J.J.M., C.W., S.G., P.J.K.), Dublin; School of Medicine (J.J.M., S.G., P.J.K.), University College Dublin (UCD); Stroke Service (J.J.M., S.G.), Department of Geriatric Medicine and Department of Neurology (P.J.K.), Mater Misericordiae University Hospital, Dublin; Health Research Institute and Mathematics Applications Consortium for Science and Industry (MACSI) (C.W.), Department of Mathematics and Statistics, University of Limerick, Ireland; George Institute for Global Health (K.H.), University of New South Wales, Sydney, Australia; Neuroimaging and Biotechnology Laboratory (NOBEL) (P.H., R.I.-R.), Clinical Neuroscience Research Laboratory, Health Research Institute of Santiago de Compostela, Spain; Department of Laboratory Medicine (C.J., A.P.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg; Department of Clinical Genetics and Genomics (C.J., A.P.), Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Wolfson Centre for the Prevention of Stroke and Dementia (L.L., P.M.R.) and Nuffield Department of Population Health (W.N.W.), University of Oxford, United Kingdom; Department of Neurology (N.M., Y.U.), Juntendo University School of Medicine, Tokyo, Japan; Department of Neurology (J.M.), Hospital Universitari Vall d'Hebron, Barcelona; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Neurology; Virgen Macarena Hospital (J.M.), Neurology, Sevilla; Neurovascular Research Laboratory (J.M.), Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona; Department of Neurology (F.F.P., M.V.-P.), Hospital Universitari Arnau de Vilanova; Department of Clinical Neurosciences (F.F.P., M.V.-P.), Institut Reserca Biomèdica Lleida, University of Lleida, Spain; Centre for Medical Informatics (C.L.S., W.N.W.), Usher Institute of Population Health Sciences and Informatics; Centre for Clinical Brain Sciences (C.L.S.), University of Edinburgh; and George Institute for Global Health (M.W.), Imperial College London, United Kingdom
| | - Joan Montaner
- From the Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI) (J.J.M., C.W., S.G., P.J.K.), Dublin; School of Medicine (J.J.M., S.G., P.J.K.), University College Dublin (UCD); Stroke Service (J.J.M., S.G.), Department of Geriatric Medicine and Department of Neurology (P.J.K.), Mater Misericordiae University Hospital, Dublin; Health Research Institute and Mathematics Applications Consortium for Science and Industry (MACSI) (C.W.), Department of Mathematics and Statistics, University of Limerick, Ireland; George Institute for Global Health (K.H.), University of New South Wales, Sydney, Australia; Neuroimaging and Biotechnology Laboratory (NOBEL) (P.H., R.I.-R.), Clinical Neuroscience Research Laboratory, Health Research Institute of Santiago de Compostela, Spain; Department of Laboratory Medicine (C.J., A.P.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg; Department of Clinical Genetics and Genomics (C.J., A.P.), Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Wolfson Centre for the Prevention of Stroke and Dementia (L.L., P.M.R.) and Nuffield Department of Population Health (W.N.W.), University of Oxford, United Kingdom; Department of Neurology (N.M., Y.U.), Juntendo University School of Medicine, Tokyo, Japan; Department of Neurology (J.M.), Hospital Universitari Vall d'Hebron, Barcelona; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Neurology; Virgen Macarena Hospital (J.M.), Neurology, Sevilla; Neurovascular Research Laboratory (J.M.), Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona; Department of Neurology (F.F.P., M.V.-P.), Hospital Universitari Arnau de Vilanova; Department of Clinical Neurosciences (F.F.P., M.V.-P.), Institut Reserca Biomèdica Lleida, University of Lleida, Spain; Centre for Medical Informatics (C.L.S., W.N.W.), Usher Institute of Population Health Sciences and Informatics; Centre for Clinical Brain Sciences (C.L.S.), University of Edinburgh; and George Institute for Global Health (M.W.), Imperial College London, United Kingdom
| | - Annie Pedersen
- From the Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI) (J.J.M., C.W., S.G., P.J.K.), Dublin; School of Medicine (J.J.M., S.G., P.J.K.), University College Dublin (UCD); Stroke Service (J.J.M., S.G.), Department of Geriatric Medicine and Department of Neurology (P.J.K.), Mater Misericordiae University Hospital, Dublin; Health Research Institute and Mathematics Applications Consortium for Science and Industry (MACSI) (C.W.), Department of Mathematics and Statistics, University of Limerick, Ireland; George Institute for Global Health (K.H.), University of New South Wales, Sydney, Australia; Neuroimaging and Biotechnology Laboratory (NOBEL) (P.H., R.I.-R.), Clinical Neuroscience Research Laboratory, Health Research Institute of Santiago de Compostela, Spain; Department of Laboratory Medicine (C.J., A.P.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg; Department of Clinical Genetics and Genomics (C.J., A.P.), Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Wolfson Centre for the Prevention of Stroke and Dementia (L.L., P.M.R.) and Nuffield Department of Population Health (W.N.W.), University of Oxford, United Kingdom; Department of Neurology (N.M., Y.U.), Juntendo University School of Medicine, Tokyo, Japan; Department of Neurology (J.M.), Hospital Universitari Vall d'Hebron, Barcelona; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Neurology; Virgen Macarena Hospital (J.M.), Neurology, Sevilla; Neurovascular Research Laboratory (J.M.), Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona; Department of Neurology (F.F.P., M.V.-P.), Hospital Universitari Arnau de Vilanova; Department of Clinical Neurosciences (F.F.P., M.V.-P.), Institut Reserca Biomèdica Lleida, University of Lleida, Spain; Centre for Medical Informatics (C.L.S., W.N.W.), Usher Institute of Population Health Sciences and Informatics; Centre for Clinical Brain Sciences (C.L.S.), University of Edinburgh; and George Institute for Global Health (M.W.), Imperial College London, United Kingdom
| | - Francisco F Purroy
- From the Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI) (J.J.M., C.W., S.G., P.J.K.), Dublin; School of Medicine (J.J.M., S.G., P.J.K.), University College Dublin (UCD); Stroke Service (J.J.M., S.G.), Department of Geriatric Medicine and Department of Neurology (P.J.K.), Mater Misericordiae University Hospital, Dublin; Health Research Institute and Mathematics Applications Consortium for Science and Industry (MACSI) (C.W.), Department of Mathematics and Statistics, University of Limerick, Ireland; George Institute for Global Health (K.H.), University of New South Wales, Sydney, Australia; Neuroimaging and Biotechnology Laboratory (NOBEL) (P.H., R.I.-R.), Clinical Neuroscience Research Laboratory, Health Research Institute of Santiago de Compostela, Spain; Department of Laboratory Medicine (C.J., A.P.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg; Department of Clinical Genetics and Genomics (C.J., A.P.), Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Wolfson Centre for the Prevention of Stroke and Dementia (L.L., P.M.R.) and Nuffield Department of Population Health (W.N.W.), University of Oxford, United Kingdom; Department of Neurology (N.M., Y.U.), Juntendo University School of Medicine, Tokyo, Japan; Department of Neurology (J.M.), Hospital Universitari Vall d'Hebron, Barcelona; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Neurology; Virgen Macarena Hospital (J.M.), Neurology, Sevilla; Neurovascular Research Laboratory (J.M.), Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona; Department of Neurology (F.F.P., M.V.-P.), Hospital Universitari Arnau de Vilanova; Department of Clinical Neurosciences (F.F.P., M.V.-P.), Institut Reserca Biomèdica Lleida, University of Lleida, Spain; Centre for Medical Informatics (C.L.S., W.N.W.), Usher Institute of Population Health Sciences and Informatics; Centre for Clinical Brain Sciences (C.L.S.), University of Edinburgh; and George Institute for Global Health (M.W.), Imperial College London, United Kingdom
| | - Peter M Rothwell
- From the Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI) (J.J.M., C.W., S.G., P.J.K.), Dublin; School of Medicine (J.J.M., S.G., P.J.K.), University College Dublin (UCD); Stroke Service (J.J.M., S.G.), Department of Geriatric Medicine and Department of Neurology (P.J.K.), Mater Misericordiae University Hospital, Dublin; Health Research Institute and Mathematics Applications Consortium for Science and Industry (MACSI) (C.W.), Department of Mathematics and Statistics, University of Limerick, Ireland; George Institute for Global Health (K.H.), University of New South Wales, Sydney, Australia; Neuroimaging and Biotechnology Laboratory (NOBEL) (P.H., R.I.-R.), Clinical Neuroscience Research Laboratory, Health Research Institute of Santiago de Compostela, Spain; Department of Laboratory Medicine (C.J., A.P.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg; Department of Clinical Genetics and Genomics (C.J., A.P.), Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Wolfson Centre for the Prevention of Stroke and Dementia (L.L., P.M.R.) and Nuffield Department of Population Health (W.N.W.), University of Oxford, United Kingdom; Department of Neurology (N.M., Y.U.), Juntendo University School of Medicine, Tokyo, Japan; Department of Neurology (J.M.), Hospital Universitari Vall d'Hebron, Barcelona; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Neurology; Virgen Macarena Hospital (J.M.), Neurology, Sevilla; Neurovascular Research Laboratory (J.M.), Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona; Department of Neurology (F.F.P., M.V.-P.), Hospital Universitari Arnau de Vilanova; Department of Clinical Neurosciences (F.F.P., M.V.-P.), Institut Reserca Biomèdica Lleida, University of Lleida, Spain; Centre for Medical Informatics (C.L.S., W.N.W.), Usher Institute of Population Health Sciences and Informatics; Centre for Clinical Brain Sciences (C.L.S.), University of Edinburgh; and George Institute for Global Health (M.W.), Imperial College London, United Kingdom
| | - Cathie L Sudlow
- From the Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI) (J.J.M., C.W., S.G., P.J.K.), Dublin; School of Medicine (J.J.M., S.G., P.J.K.), University College Dublin (UCD); Stroke Service (J.J.M., S.G.), Department of Geriatric Medicine and Department of Neurology (P.J.K.), Mater Misericordiae University Hospital, Dublin; Health Research Institute and Mathematics Applications Consortium for Science and Industry (MACSI) (C.W.), Department of Mathematics and Statistics, University of Limerick, Ireland; George Institute for Global Health (K.H.), University of New South Wales, Sydney, Australia; Neuroimaging and Biotechnology Laboratory (NOBEL) (P.H., R.I.-R.), Clinical Neuroscience Research Laboratory, Health Research Institute of Santiago de Compostela, Spain; Department of Laboratory Medicine (C.J., A.P.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg; Department of Clinical Genetics and Genomics (C.J., A.P.), Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Wolfson Centre for the Prevention of Stroke and Dementia (L.L., P.M.R.) and Nuffield Department of Population Health (W.N.W.), University of Oxford, United Kingdom; Department of Neurology (N.M., Y.U.), Juntendo University School of Medicine, Tokyo, Japan; Department of Neurology (J.M.), Hospital Universitari Vall d'Hebron, Barcelona; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Neurology; Virgen Macarena Hospital (J.M.), Neurology, Sevilla; Neurovascular Research Laboratory (J.M.), Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona; Department of Neurology (F.F.P., M.V.-P.), Hospital Universitari Arnau de Vilanova; Department of Clinical Neurosciences (F.F.P., M.V.-P.), Institut Reserca Biomèdica Lleida, University of Lleida, Spain; Centre for Medical Informatics (C.L.S., W.N.W.), Usher Institute of Population Health Sciences and Informatics; Centre for Clinical Brain Sciences (C.L.S.), University of Edinburgh; and George Institute for Global Health (M.W.), Imperial College London, United Kingdom
| | - Yuji Ueno
- From the Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI) (J.J.M., C.W., S.G., P.J.K.), Dublin; School of Medicine (J.J.M., S.G., P.J.K.), University College Dublin (UCD); Stroke Service (J.J.M., S.G.), Department of Geriatric Medicine and Department of Neurology (P.J.K.), Mater Misericordiae University Hospital, Dublin; Health Research Institute and Mathematics Applications Consortium for Science and Industry (MACSI) (C.W.), Department of Mathematics and Statistics, University of Limerick, Ireland; George Institute for Global Health (K.H.), University of New South Wales, Sydney, Australia; Neuroimaging and Biotechnology Laboratory (NOBEL) (P.H., R.I.-R.), Clinical Neuroscience Research Laboratory, Health Research Institute of Santiago de Compostela, Spain; Department of Laboratory Medicine (C.J., A.P.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg; Department of Clinical Genetics and Genomics (C.J., A.P.), Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Wolfson Centre for the Prevention of Stroke and Dementia (L.L., P.M.R.) and Nuffield Department of Population Health (W.N.W.), University of Oxford, United Kingdom; Department of Neurology (N.M., Y.U.), Juntendo University School of Medicine, Tokyo, Japan; Department of Neurology (J.M.), Hospital Universitari Vall d'Hebron, Barcelona; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Neurology; Virgen Macarena Hospital (J.M.), Neurology, Sevilla; Neurovascular Research Laboratory (J.M.), Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona; Department of Neurology (F.F.P., M.V.-P.), Hospital Universitari Arnau de Vilanova; Department of Clinical Neurosciences (F.F.P., M.V.-P.), Institut Reserca Biomèdica Lleida, University of Lleida, Spain; Centre for Medical Informatics (C.L.S., W.N.W.), Usher Institute of Population Health Sciences and Informatics; Centre for Clinical Brain Sciences (C.L.S.), University of Edinburgh; and George Institute for Global Health (M.W.), Imperial College London, United Kingdom
| | - Mikel Vicente-Pascual
- From the Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI) (J.J.M., C.W., S.G., P.J.K.), Dublin; School of Medicine (J.J.M., S.G., P.J.K.), University College Dublin (UCD); Stroke Service (J.J.M., S.G.), Department of Geriatric Medicine and Department of Neurology (P.J.K.), Mater Misericordiae University Hospital, Dublin; Health Research Institute and Mathematics Applications Consortium for Science and Industry (MACSI) (C.W.), Department of Mathematics and Statistics, University of Limerick, Ireland; George Institute for Global Health (K.H.), University of New South Wales, Sydney, Australia; Neuroimaging and Biotechnology Laboratory (NOBEL) (P.H., R.I.-R.), Clinical Neuroscience Research Laboratory, Health Research Institute of Santiago de Compostela, Spain; Department of Laboratory Medicine (C.J., A.P.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg; Department of Clinical Genetics and Genomics (C.J., A.P.), Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Wolfson Centre for the Prevention of Stroke and Dementia (L.L., P.M.R.) and Nuffield Department of Population Health (W.N.W.), University of Oxford, United Kingdom; Department of Neurology (N.M., Y.U.), Juntendo University School of Medicine, Tokyo, Japan; Department of Neurology (J.M.), Hospital Universitari Vall d'Hebron, Barcelona; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Neurology; Virgen Macarena Hospital (J.M.), Neurology, Sevilla; Neurovascular Research Laboratory (J.M.), Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona; Department of Neurology (F.F.P., M.V.-P.), Hospital Universitari Arnau de Vilanova; Department of Clinical Neurosciences (F.F.P., M.V.-P.), Institut Reserca Biomèdica Lleida, University of Lleida, Spain; Centre for Medical Informatics (C.L.S., W.N.W.), Usher Institute of Population Health Sciences and Informatics; Centre for Clinical Brain Sciences (C.L.S.), University of Edinburgh; and George Institute for Global Health (M.W.), Imperial College London, United Kingdom
| | - Will N Whiteley
- From the Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI) (J.J.M., C.W., S.G., P.J.K.), Dublin; School of Medicine (J.J.M., S.G., P.J.K.), University College Dublin (UCD); Stroke Service (J.J.M., S.G.), Department of Geriatric Medicine and Department of Neurology (P.J.K.), Mater Misericordiae University Hospital, Dublin; Health Research Institute and Mathematics Applications Consortium for Science and Industry (MACSI) (C.W.), Department of Mathematics and Statistics, University of Limerick, Ireland; George Institute for Global Health (K.H.), University of New South Wales, Sydney, Australia; Neuroimaging and Biotechnology Laboratory (NOBEL) (P.H., R.I.-R.), Clinical Neuroscience Research Laboratory, Health Research Institute of Santiago de Compostela, Spain; Department of Laboratory Medicine (C.J., A.P.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg; Department of Clinical Genetics and Genomics (C.J., A.P.), Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Wolfson Centre for the Prevention of Stroke and Dementia (L.L., P.M.R.) and Nuffield Department of Population Health (W.N.W.), University of Oxford, United Kingdom; Department of Neurology (N.M., Y.U.), Juntendo University School of Medicine, Tokyo, Japan; Department of Neurology (J.M.), Hospital Universitari Vall d'Hebron, Barcelona; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Neurology; Virgen Macarena Hospital (J.M.), Neurology, Sevilla; Neurovascular Research Laboratory (J.M.), Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona; Department of Neurology (F.F.P., M.V.-P.), Hospital Universitari Arnau de Vilanova; Department of Clinical Neurosciences (F.F.P., M.V.-P.), Institut Reserca Biomèdica Lleida, University of Lleida, Spain; Centre for Medical Informatics (C.L.S., W.N.W.), Usher Institute of Population Health Sciences and Informatics; Centre for Clinical Brain Sciences (C.L.S.), University of Edinburgh; and George Institute for Global Health (M.W.), Imperial College London, United Kingdom
| | - Mark Woodward
- From the Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI) (J.J.M., C.W., S.G., P.J.K.), Dublin; School of Medicine (J.J.M., S.G., P.J.K.), University College Dublin (UCD); Stroke Service (J.J.M., S.G.), Department of Geriatric Medicine and Department of Neurology (P.J.K.), Mater Misericordiae University Hospital, Dublin; Health Research Institute and Mathematics Applications Consortium for Science and Industry (MACSI) (C.W.), Department of Mathematics and Statistics, University of Limerick, Ireland; George Institute for Global Health (K.H.), University of New South Wales, Sydney, Australia; Neuroimaging and Biotechnology Laboratory (NOBEL) (P.H., R.I.-R.), Clinical Neuroscience Research Laboratory, Health Research Institute of Santiago de Compostela, Spain; Department of Laboratory Medicine (C.J., A.P.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg; Department of Clinical Genetics and Genomics (C.J., A.P.), Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Wolfson Centre for the Prevention of Stroke and Dementia (L.L., P.M.R.) and Nuffield Department of Population Health (W.N.W.), University of Oxford, United Kingdom; Department of Neurology (N.M., Y.U.), Juntendo University School of Medicine, Tokyo, Japan; Department of Neurology (J.M.), Hospital Universitari Vall d'Hebron, Barcelona; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Neurology; Virgen Macarena Hospital (J.M.), Neurology, Sevilla; Neurovascular Research Laboratory (J.M.), Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona; Department of Neurology (F.F.P., M.V.-P.), Hospital Universitari Arnau de Vilanova; Department of Clinical Neurosciences (F.F.P., M.V.-P.), Institut Reserca Biomèdica Lleida, University of Lleida, Spain; Centre for Medical Informatics (C.L.S., W.N.W.), Usher Institute of Population Health Sciences and Informatics; Centre for Clinical Brain Sciences (C.L.S.), University of Edinburgh; and George Institute for Global Health (M.W.), Imperial College London, United Kingdom
| | - Peter J Kelly
- From the Health Research Board (HRB) Stroke Clinical Trials Network Ireland (SCTNI) (J.J.M., C.W., S.G., P.J.K.), Dublin; School of Medicine (J.J.M., S.G., P.J.K.), University College Dublin (UCD); Stroke Service (J.J.M., S.G.), Department of Geriatric Medicine and Department of Neurology (P.J.K.), Mater Misericordiae University Hospital, Dublin; Health Research Institute and Mathematics Applications Consortium for Science and Industry (MACSI) (C.W.), Department of Mathematics and Statistics, University of Limerick, Ireland; George Institute for Global Health (K.H.), University of New South Wales, Sydney, Australia; Neuroimaging and Biotechnology Laboratory (NOBEL) (P.H., R.I.-R.), Clinical Neuroscience Research Laboratory, Health Research Institute of Santiago de Compostela, Spain; Department of Laboratory Medicine (C.J., A.P.), Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg; Department of Clinical Genetics and Genomics (C.J., A.P.), Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Wolfson Centre for the Prevention of Stroke and Dementia (L.L., P.M.R.) and Nuffield Department of Population Health (W.N.W.), University of Oxford, United Kingdom; Department of Neurology (N.M., Y.U.), Juntendo University School of Medicine, Tokyo, Japan; Department of Neurology (J.M.), Hospital Universitari Vall d'Hebron, Barcelona; Institute de Biomedicine of Seville (J.M.), IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Neurology; Virgen Macarena Hospital (J.M.), Neurology, Sevilla; Neurovascular Research Laboratory (J.M.), Vall d'Hebron Institute of Research, Universitat Autònoma de Barcelona; Department of Neurology (F.F.P., M.V.-P.), Hospital Universitari Arnau de Vilanova; Department of Clinical Neurosciences (F.F.P., M.V.-P.), Institut Reserca Biomèdica Lleida, University of Lleida, Spain; Centre for Medical Informatics (C.L.S., W.N.W.), Usher Institute of Population Health Sciences and Informatics; Centre for Clinical Brain Sciences (C.L.S.), University of Edinburgh; and George Institute for Global Health (M.W.), Imperial College London, United Kingdom
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6
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Zuo L, Dong Y, Liao X, Hu Y, Pan Y, Yan H, Wang X, Zhao X, Wang Y, Seet RCS, Wang Y, Li Z. Low HALP (Hemoglobin, Albumin, Lymphocyte, and Platelet) Score Increases the Risk of Post-Stroke Cognitive Impairment: A Multicenter Cohort Study. Clin Interv Aging 2024; 19:81-92. [PMID: 38223135 PMCID: PMC10788070 DOI: 10.2147/cia.s432885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/24/2023] [Indexed: 01/16/2024] Open
Abstract
Objective The HALP (hemoglobin, albumin, lymphocyte, and platelet) score is a novel indicator that measures systemic inflammation and nutritional status that has not been correlated with the risk of post-stroke cognitive impairment in patients with acute ischemic stroke or transient ischemic attack (TIA). Methods Study participants were recruited from 40 stroke centers in China. The HALP score was derived using a weighted sum of hemoglobin, albumin, lymphocytes and platelets, and study participants were categorized into 4 groups of equal sizes based on quartiles cutoffs of the HALP score. The Montreal Cognitive Assessment (MoCA)-Beijing Cognitive Assessment Scale (MoCA-Beijing) was performed at 2 weeks and 12 months following stroke onset. Post-stroke cognitive impairment was considered in patients with MoCA-Beijing≤22. Multiple logistic regression methods were employed to evaluate the relationship between the HALP score and the subsequent risk of developing post-stroke cognitive impairment. Results The study population comprised 1022 patients (mean age 61.6±11.0 years, 73% men). The proportion of individuals with MoCA-Beijing≤22 at 2 weeks was 49.2% and 32.4% at one year. Patients in the lowest quartile of HALP score (<36.56) were observed to harbor the highest risk of post-stroke cognitive impairment at 12 months post-stroke/TIA compared to those in the highest quartile (odds ratio=1.59, 95% CI=1.07-2.37, p=0.022), and lower domain scores for executive function, naming, and attention. There were no statistically significant differences between patients in the different quartiles of HALP score and HALP score at 2 weeks post-stroke/TIA. Conclusion The HALP score is a simple score that could stratify the risk of post-stroke cognitive impairment in stroke/TIA patients to facilitate early diagnosis and interventions.
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Affiliation(s)
- Lijun Zuo
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yanhong Dong
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Singapore
| | - Xiaoling Liao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yang Hu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yuesong Pan
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Hongyi Yan
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Xingao Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Raymond C S Seet
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Neurology, Department of Medicine, National University Hospital, Singapore
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Zixiao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
- Beijing Tiantan Hospital, Capital Medical University, and the Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
- National Center for Healthcare Quality Management in Neurological Diseases, Beijing, People’s Republic of China
- Chinese Institute for Brain Research, Beijing, People’s Republic of China
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7
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Jiang M, Li Y, Chen Y, Fan J, Zhao Z, Long W, Huang H, Tang C, Luo F, Li M, Lin B, Xiao N, Wu S, Ding J. Gait Parameters can Reflect Cognitive Performance in Older Adults with Cerebral Small Vessel Disease: A Cross-sectional Research. Curr Neurovasc Res 2024; 20:568-577. [PMID: 38509689 DOI: 10.2174/0115672026281431231212052728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 10/11/2023] [Accepted: 10/14/2023] [Indexed: 03/22/2024]
Abstract
BACKGROUND Cerebral small vessel disease (CSVD) is a common chronic progressive disease. It remains unclear whether high gait variability is a marker of cognitive cortical dysfunction. METHODS This study included 285 subjects (aged from 60 to 85 years, 60.3% female) including 37 controls, 179 presented as Fazekas II, and 69 presented as Fazekas III. The severity of white matter hyperintensities was assessed by the Fazekas Rating Scale. Gait parameters were assessed using a vision-based artificial intelligent gait analyzer. Cognitive function was tested by MMSE, MoCA, DST, and VFT. RESULTS Three gait parameters including gait speed, gait length, and swing time were associated with cognitive performance in patients with CSVD. Gait speed was associated with cognitive performance, including MMSE (β 0.200; 95%CI 1.706-6.018; p <.001), MoCA (β 0.183; 95%CI 2.047-7.046; p <.001), DST (order) (β 0.204; 95%CI 0.563-2.093; p =.001) and VFT (β 0.162; 95%CI 0.753-4.865; p =.008). Gait length was associated with cognitive performance, including MMSE (β 0.193; 95%CI 3.475-12.845; p =.001), MoCA (β 0.213; 95%CI 6.098-16.942; p <.001), DST (order) (β 0.224; 95%CI 1.056-4.839; P <.001) and VFT (β 0.149; 95%CI 1.088- 10.114; p =.015). Swing time was associated with cognitive performance, including MMSE (β - 0.242; 95%CI -2.639 to -0.974; p<.001), MoCA (β -0.211; 95%CI -2.989 to -1.034; p <.001) and DST (reverse order) (β -0.140; 95%CI -0.568 to -0.049; p =.020). CONCLUSION This study revealed that the relationship between gait parameters and cognitive performance in patients with CSVD and the deteriorated gait parameters can reflect cognitive impairment and even dementia in older people with CSVD.
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Affiliation(s)
- Mingzhu Jiang
- Department of Neurology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Yan Li
- Department of Neurology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Ying Chen
- Department of Neurology, Xingyi People's Hospital, Qianxinan Buyei and Miao Autonomous Prefecture, Guizhou, China
| | - Jinying Fan
- Department of Neurology, Kaili First People's Hospital, Qiandongnan Miao and Dong Autonomous Prefecture, Guizhou, China
| | - Zhiqin Zhao
- Department of Neurology, Huaxi District People's Hospital, Guiyang, Guizhou, China
| | - Wenkai Long
- Department of Neurology, Danzhai County People's Hospital, Qiandongnan Miao and Dong Autonomous Prefecture, Guizhou, China
| | - Hailun Huang
- Department of Neurology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Chao Tang
- Department of Neurology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Fang Luo
- Department of Neurology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Mi Li
- Department of Neurology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Bo Lin
- Department of Neurology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Ning Xiao
- Department of Neurology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Shan Wu
- Department of Neurology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Jing Ding
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
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8
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Goldney J, Sargeant JA, Davies MJ. Incretins and microvascular complications of diabetes: neuropathy, nephropathy, retinopathy and microangiopathy. Diabetologia 2023; 66:1832-1845. [PMID: 37597048 PMCID: PMC10474214 DOI: 10.1007/s00125-023-05988-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/17/2023] [Indexed: 08/21/2023]
Abstract
Glucagon-like peptide-1 receptor agonists (GLP-1RAs, incretin mimetics) and dipeptidyl peptidase-4 inhibitors (DPP-4is, incretin enhancers) are glucose-lowering therapies with proven cardiovascular safety, but their effect on microvascular disease is not fully understood. Both therapies increase GLP-1 receptor agonism, which is associated with attenuation of numerous pathological processes that may lead to microvascular benefits, including decreased reactive oxygen species (ROS) production, decreased inflammation and improved vascular function. DPP-4is also increase stromal cell-derived factor-1 (SDF-1), which is associated with neovascularisation and tissue repair. Rodent studies demonstrate several benefits of these agents in the prevention or reversal of nephropathy, retinopathy and neuropathy, but evidence from human populations is less clear. For nephropathy risk in human clinical trials, meta-analyses demonstrate that GLP-1RAs reduce the risk of a composite renal outcome (doubling of serum creatinine, eGFR reduction of 30%, end-stage renal disease or renal death), whereas the benefits of DPP-4is appear to be limited to reductions in the risk of albuminuria. The relationship between GLP-1RAs and retinopathy is less clear. Many large trials and meta-analyses show no effect, but an observed increase in the risk of retinopathy complications with semaglutide therapy (a GLP-1RA) in the SUSTAIN-6 trial warrants caution, particularly in individuals with baseline retinopathy. Similarly, DPP-4is are associated with increased retinopathy risk in both trials and meta-analysis. The association between GLP-1RAs and peripheral neuropathy is unclear due to little trial evidence. For DPP-4is, one trial and several observational studies show a reduced risk of peripheral neuropathy, with others reporting no effect. Evidence in other less-established microvascular outcomes, such as microvascular angina, cerebral small vessel disease, skeletal muscle microvascular disease and autonomic neuropathies (e.g. cardiac autonomic neuropathy, gastroparesis, erectile dysfunction), is sparse. In conclusion, GLP-1RAs are protective against nephropathy, whereas DPP-4is are protective against albuminuria and potentially peripheral neuropathy. Caution is advised with DPP-4is and semaglutide, particularly for patients with background retinopathy, due to increased risk of retinopathy. Well-designed trials powered for microvascular outcomes are needed to clarify associations of incretin therapies and microvascular diseases.
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Affiliation(s)
- Jonathan Goldney
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK.
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK.
| | - Jack A Sargeant
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
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Wang Y, Cai X, Li H, Jin A, Jiang L, Chen W, Jing J, Mei L, Li S, Meng X, Wei T, Wang Y, Pan Y, Wang Y. Association of intracranial atherosclerosis with cerebral small vessel disease in a community-based population. Eur J Neurol 2023; 30:2700-2712. [PMID: 37294661 DOI: 10.1111/ene.15908] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/01/2023] [Accepted: 06/05/2023] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to explore the relationship between intracranial atherosclerosis and cerebral small vessel disease (CSVD). METHODS Community-dwelling residents of Lishui, China in the PRECISE (Polyvascular Evaluation for Cognitive Impairment and Vascular Events) study were involved. Intracranial atherosclerosis was grouped by the severity of intracranial artery plaques with stenosis and burden. Four imaging markers including lacunes, white matter hyperintensity (WMH), cerebral microbleeds (CMBs), and perivascular spaces (PVS) as well as the CSVD burden scores were assessed. Logistic regression or ordinal logistic regression models with odds ratio (OR) or common OR (cOR) were used to estimate the relationship between intracranial atherosclerosis and CSVD markers and burdens. RESULTS The mean age was 61.20 ± 6.68 years, and 1424 (46.52%) were men among 3061 participants included at baseline. Intracranial atherosclerotic burden was associated with the severity of the lacunes (OR = 4.18, 95% confidence interval [CI] = 1.83-9.58), modified WMH burden (cOR = 1.94, 95% CI = 1.01-3.71), presence of CMBs (OR = 2.28, 95% CI = 1.05-4.94), and CMB burden (OR = 2.23, 95% CI = 1.03-4.80). However, it was not associated with the WMH burden and PVS. Intracranial atherosclerotic burden was associated with CSVD burden (Wardlaw: cOR = 2.73, 95% CI = 1.48-5.05; Rothwell: cOR = 2.70, 95% CI = 1.47-4.95). The association between intracranial atherosclerosis and CSVD was obvious in participants with both anterior and posterior circulation artery stenosis. CONCLUSIONS Based on a Chinese community population, there may be an association between intracranial atherosclerosis and CSVD, but its mechanism in relation to vascular risk factors still needs to be clarified.
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Affiliation(s)
- Yicong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xueli Cai
- Department of Neurology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China
- Lishui Clinical Research Center for Neurological Diseases, Lishui, China
| | - Hang Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Department of Geriatrics, Affiliated Dalian Friendship Hospital of Dalian Medical University, Dalian, China
| | - Aoming Jin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Lingling Jiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Weiqi Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, 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
| | - Lerong Mei
- Cerebrovascular Research Lab, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China
| | - Shan Li
- Cerebrovascular Research Lab, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Tiemin Wei
- Department of Cardiology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
- Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, China
- Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, 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
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Chinese Institute for Brain Research, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
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10
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Zhou X, Huang H, Qu W, Yu Z, Zhao J, Wu L, Zhang Y, Kong Q, Wang Z, Luo X. Type A personality, sleep quality, and cerebral small vessel disease: investigating the mediating role of sleep in a community-based study. Front Neurol 2023; 14:1236670. [PMID: 37602263 PMCID: PMC10437815 DOI: 10.3389/fneur.2023.1236670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/10/2023] [Indexed: 08/22/2023] Open
Abstract
Purpose Type A behavior pattern (TABP) is a personality type characterized by rapid speech, impatience, competition, and hostility. Asymptomatic cerebral small vessel disease (CSVD) is often endemic in older adults. Individuals with TABP commonly experience suboptimal sleep quality, and a correlation exists between sleep disturbances and CSVD. We investigated the relationship between TABP and CSVD markers and further explored the mediating role of sleep quality in the relationship between TABP and CSVD. Methods A cross-sectional survey included 764 community-dwelling adults aged 55-85 years. The TABP Scale and the Pittsburgh Sleep Quality Index (PSQI) were used to assess personality and sleep quality, respectively. Linear and logistic regression analyses were used to examine relationships between variables of interest. In addition, mediation analyses with bootstrapping were used to test whether sleep quality mediated the relationship between TABP and CSVD. Results Of the 764 participants [median age 65 (61-69) years, 59.9% female], the population with type A personality accounted for 44.8%. After adjusting for covariates, TABP scores (p = 0.03) and PSQI scores (p < 0.001) were significantly correlated with CSVD. In addition, sleep quality partially mediated the association between type A behavior and CSVD, and the mediating effect was 10.67%. Conclusion This study showed that type A behavior was a risk factor for CSVD among older community-dwelling adults and that sleep quality mediated the relationship between type A behavior and CSVD. Changing type A behavior may help improve sleep quality, which may in turn reduce the prevalence of CSVD.
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Affiliation(s)
- Xirui Zhou
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Hao Huang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wensheng Qu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhiyuan Yu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jing Zhao
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Lingshan Wu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yi Zhang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qianqian Kong
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ziyue Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiang Luo
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, Hubei, China
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11
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Zhan Z, Xu T, Xu Y, Fu F, Cheng Z, Xia L, Wu Y, Xu X, Cao Y, Han Z. Associations between computed tomography markers of cerebral small vessel disease and hemorrhagic transformation after intravenous thrombolysis in acute ischemic stroke patients. Front Neurol 2023; 14:1144564. [PMID: 37077565 PMCID: PMC10106596 DOI: 10.3389/fneur.2023.1144564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/20/2023] [Indexed: 04/05/2023] Open
Abstract
BackgroundHemorrhagic transformation (HT) is common among acute ischemic stroke patients after treatment with intravenous thrombolysis (IVT). We analyzed potential relationships between markers of cerebral small vessel disease (CSVD) and HT in patients after IVT.MethodsThis study retrospectively analyzed computed tomography (CT) data for acute ischemic stroke patients before and after treatment with recombinant tissue plasminogen activator at a large Chinese hospital between July 2014 and June 2021. Total CSVD score were summed by individual CSVD markers including leukoaraiosis, brain atrophy and lacune. Binary regression analysis was used to explore whether CSVD markers were related to HT as the primary outcome or to symptomatic intracranial hemorrhage (sICH) as a secondary outcome.ResultsA total of 397 AIS patients treated with IVT were screened for inclusion in this study. Patients with missing laboratory data (n = 37) and patients treated with endovascular therapy (n = 42) were excluded. Of the 318 patients included, 54 (17.0%) developed HT within 24–36 h of IVT, and 14 (4.3%) developed sICH. HT risk was independently associated with severe brain atrophy (OR 3.14, 95%CI 1.43–6.92, P = 0.004) and severe leukoaraiosis (OR 2.41, 95%CI 1.05–5.50, P = 0.036), but not to severe lacune level (OR 0.58, 95%CI 0.23–1.45, P = 0.250). Patients with a total CSVD burden ≥1 were at higher risk of HT (OR 2.87, 95%CI 1.38–5.94, P = 0.005). However, occurrence of sICH was not predicted by CSVD markers or total CSVD burden.ConclusionIn patients with acute ischemic stroke, severe leukoaraiosis, brain atrophy and total CSVD burden may be risk factors for HT after IVT. These findings may help improve efforts to mitigate or even prevent HT in vulnerable patients.
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Affiliation(s)
- Zhenxiang Zhan
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Department of Neurology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Tong Xu
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ye Xu
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Fangwang Fu
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zicheng Cheng
- Department of Neurology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Lingfan Xia
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yucong Wu
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xuan Xu
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yungang Cao
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhao Han
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- *Correspondence: Zhao Han
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12
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Zhao J, Wang X, Li Q, Lu C, Li S. The relevance of serum macrophage migratory inhibitory factor and cognitive dysfunction in patients with cerebral small vascular disease. Front Aging Neurosci 2023; 15:1083818. [PMID: 36824264 PMCID: PMC9941340 DOI: 10.3389/fnagi.2023.1083818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/18/2023] [Indexed: 02/10/2023] Open
Abstract
Cerebral small vascular disease (CSVD) is a common type of cerebrovascular disease, and an important cause of vascular cognitive impairment (VCI) and stroke. The disease burden is expected to increase further as a result of population aging, an ongoing high prevalence of risk factors (e.g., hypertension), and inadequate management. Due to the poor understanding of pathophysiology in CSVD, there is no effective preventive or therapeutic approach for CSVD. Macrophage migration inhibitory factor (MIF) is a multifunctional cytokine that is related to the occurrence and development of vascular dysfunction diseases. Therefore, MIF may contribute to the pathogenesis of CSVD and VCI. Here, reviewed MIF participation in chronic cerebral ischemia-hypoperfusion and neurodegeneration pathology, including new evidence for CSVD, and its potential role in protection against VCI.
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Affiliation(s)
- Jianhua Zhao
- Henan Joint International Research Laboratory of Neurorestoratology for Senile Dementia, Henan Key Laboratory of Neurorestoratology, Department of Neurology, First Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China,*Correspondence: Jianhua Zhao,
| | - Xiaoting Wang
- Henan Joint International Research Laboratory of Neurorestoratology for Senile Dementia, Henan Key Laboratory of Neurorestoratology, Department of Neurology, First Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
| | - Qiong Li
- Henan Joint International Research Laboratory of Neurorestoratology for Senile Dementia, Henan Key Laboratory of Neurorestoratology, Department of Neurology, First Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
| | - Chengbiao Lu
- Sino-UK Joint Laboratory of Brain Function and Injury of Henan Province, Department of Physiology and Neurobiology, Xinxiang Medical University, Xinxiang, China
| | - Shaomin Li
- Ann Romney Center for Neurologic Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
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13
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Shi G, Ke D, Gong P, Yu P, Zhou J, Wang M, Zhang X, Wang X, Guo M, Xu M, Zhou R. Serum YKL-40 Levels and White Matter Hyperintensities in Patients with Acute Ischemic Stroke. J Inflamm Res 2023; 16:311-319. [PMID: 36721527 PMCID: PMC9884433 DOI: 10.2147/jir.s398701] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/18/2023] [Indexed: 01/25/2023] Open
Abstract
Background White matter hyperintensity (WMH) is associated with risk of acute ischemic stroke (AIS) and poor outcomes after AIS. The purpose of this prospective study was to evaluate the association between serum YKL-40 levels and WMH burden in patients with AIS. Methods From February 2020 to March 2021, a total of 672 consecutive AIS patients with magnetic resonance imaging data were prospectively recruited form two centers. Serum YKL-40 levels were quantified using enzyme-linked immunosorbent assay. The burden of WMH was semiquantitatively measured by the Fazekas visual grading scale. According to severity of overall WMH, patients were dichotomized into none-mild WMH group (Fazekas score 0-2) or moderate-severe WMH group (Fazekas score 3-6). Besides, based on severity of periventricular WMH (PV-WMH) and deep WMH (D-WMH), patients were categorized as none-mild (Fazekas score 0-1) or moderate-severe (Fazekas score 2-3). Results Among the 672 patients, 335 (49.9%) participants were identified with moderate-severe overall WMH, 326 (48.5%) with moderate-severe PV-WMH and 262 (39.0%) with moderate-severe D-WMH. Compared with the first quartile of serum YKL-40, the adjusted odds ratio (OR) of the fourth quartile for moderate-severe PV-WMH was 2.473 (95% confidence interval [CI] 1.316-4.646; P=0.005). No significant association was observed between YKL-40 and overall WMH (OR 0.762; 95% CI 0.434-1.336; P=0.343) or D-WMH (OR 0.695; 95% CI 0.413-1.171; P=0.172). Conclusion Our results suggested that higher YKL-40 levels appeared to be associated with PV-WMH, but not with overall WMH or D-WMH in patients with AIS.
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Affiliation(s)
- Guomei Shi
- Department of Neurology, the Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China,Stroke Center, the Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China
| | - Dongdong Ke
- Stroke Center, the Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China,Department of Rehabilitation, the Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China
| | - Pengyu Gong
- Department of Neurology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People’s Republic of China,Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China
| | - Peng Yu
- Stroke Center, the Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China,Department of Radiology, the Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China
| | - Junshan Zhou
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China
| | - Meng Wang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China
| | - Xiaohao Zhang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China
| | - Xiaorong Wang
- Department of Neurology, the Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China,Stroke Center, the Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China
| | - Minwang Guo
- Department of Neurology, the Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China,Stroke Center, the Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China
| | - Mingyang Xu
- Department of Neurology, the Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China,Stroke Center, the Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China
| | - Rujuan Zhou
- Department of Neurology, the Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China,Stroke Center, the Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China,Correspondence: Rujuan Zhou, Tel +86-13951158499, Email
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14
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Zedde M, Linn J, Katsanos AH, Pascarella R. Editorial: Small vessel disease: From diagnosis to organized management pathways. Front Neurol 2023; 13:1120426. [PMID: 36703631 PMCID: PMC9872149 DOI: 10.3389/fneur.2022.1120426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 12/28/2022] [Indexed: 01/12/2023] Open
Affiliation(s)
- Marialuisa Zedde
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy,*Correspondence: Marialuisa Zedde ✉
| | - Jennifer Linn
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Aristeidis H. Katsanos
- Division of Neurology, McMaster University and Population Health Research Institute, Hamilton, ON, Canada
| | - Rosario Pascarella
- Neuroradiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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15
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Solé-Guardia G, Custers E, de Lange A, Clijncke E, Geenen B, Gutierrez J, Küsters B, Claassen JAHR, de Leeuw FE, Wiesmann M, Kiliaan AJ. Association between hypertension and neurovascular inflammation in both normal-appearing white matter and white matter hyperintensities. Acta Neuropathol Commun 2023; 11:2. [PMID: 36600303 PMCID: PMC9811756 DOI: 10.1186/s40478-022-01497-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/19/2022] [Indexed: 01/05/2023] Open
Abstract
The major vascular cause of dementia is cerebral small vessel disease (SVD), including white matter hyperintensities (WMH) amongst others. While the underlying pathology of SVD remains unclear, chronic hypertension and neuroinflammation are recognized as important risk factors for SVD and for the conversion of normal-appearing white matter (NAWM) to WMH. Unfortunately, most studies investigating the role of neuroinflammation in WMH relied on peripheral blood markers, e.g., markers for systemic or vascular inflammation, as a proxy for inflammation in the brain itself. However, it is unknown whether such markers accurately capture inflammatory changes within the cerebral white matter. Therefore, we aimed to comprehensively investigate the impact of hypertension on perivascular- and neuroinflammation in both WMH and NAWM. We conducted high field brain magnetic resonance imaging (MRI), followed by (immuno-)histopathological staining of neuroinflammatory markers on human post-mortem brains of elderly people with a history of hypertension (n = 17) and age-matched normotensive individuals (n = 5). MRI images were co-registered to (immuno-)histopathological data including stainings for microglia and astroglia to assess changes in MRI-based WMH at microscopic resolution. Perivascular inflammation was carefully assessed based on the severity of perivascular astrogliosis of the smallest vessels throughout white matter regions. Hypertension was associated with a larger inflammatory response in both WMH and NAWM. Notably, the presence of close-range perivascular inflammation was twice as common among those with hypertension than in controls both in WMH and NAWM, suggesting that neurovascular inflammation is critical in the etiology of WMH. Moreover, a higher degree of microglial activation was related to a higher burden of WMH. Our results indicate that neuro(vascular)inflammation at the level of the brain itself is involved in the etiology of WMH. Future therapeutic strategies focusing on multitarget interventions including antihypertensive treatment as well as neuroinflammation may ameliorate WMH progression.
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Affiliation(s)
- Gemma Solé-Guardia
- grid.10417.330000 0004 0444 9382Department of Medical Imaging, Anatomy, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Center for Medical Neuroscience, Preclinical Imaging Center PRIME, Radboud Alzheimer Center, Nijmegen, The Netherlands
| | - Emma Custers
- grid.10417.330000 0004 0444 9382Department of Medical Imaging, Anatomy, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Center for Medical Neuroscience, Preclinical Imaging Center PRIME, Radboud Alzheimer Center, Nijmegen, The Netherlands
| | - Arthur de Lange
- grid.10417.330000 0004 0444 9382Department of Medical Imaging, Anatomy, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Center for Medical Neuroscience, Preclinical Imaging Center PRIME, Radboud Alzheimer Center, Nijmegen, The Netherlands
| | - Elyne Clijncke
- grid.10417.330000 0004 0444 9382Department of Medical Imaging, Anatomy, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Center for Medical Neuroscience, Preclinical Imaging Center PRIME, Radboud Alzheimer Center, Nijmegen, The Netherlands
| | - Bram Geenen
- grid.10417.330000 0004 0444 9382Department of Medical Imaging, Anatomy, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Center for Medical Neuroscience, Preclinical Imaging Center PRIME, Radboud Alzheimer Center, Nijmegen, The Netherlands
| | - Jose Gutierrez
- grid.239585.00000 0001 2285 2675Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University Medical Center, New York, NY USA
| | - Benno Küsters
- grid.10417.330000 0004 0444 9382Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jurgen A. H. R. Claassen
- grid.10417.330000 0004 0444 9382Department of Geriatrics, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Center for Medical Neuroscience, Radboud Alzheimer Center, Nijmegen, The Netherlands
| | - Frank-Erik de Leeuw
- grid.10417.330000 0004 0444 9382Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Center for Medical Neuroscience, Nijmegen, The Netherlands
| | - Maximilian Wiesmann
- grid.10417.330000 0004 0444 9382Department of Medical Imaging, Anatomy, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Center for Medical Neuroscience, Preclinical Imaging Center PRIME, Radboud Alzheimer Center, Nijmegen, The Netherlands
| | - Amanda J. Kiliaan
- grid.10417.330000 0004 0444 9382Department of Medical Imaging, Anatomy, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Center for Medical Neuroscience, Preclinical Imaging Center PRIME, Radboud Alzheimer Center, Nijmegen, The Netherlands
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16
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Lan H, Lei X, Xu Z, Chen S, Gong W, Cai Y. New insights in addressing cerebral small vessel disease: Associated with extracellular fluid in white matter. Front Neurosci 2022; 16:1042824. [PMID: 36340793 PMCID: PMC9631816 DOI: 10.3389/fnins.2022.1042824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/04/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To explore the role of extracellular fluid, assessed by diffusion tensor imaging (DTI) metrics of free water (FW), in the white matter of patients with cerebral small vessel disease (CSVD). Materials and methods The baseline clinical and imaging data of 129 patients with CSVD were collected and reviewed. CSVD MR markers, including periventricular white matter hyperintensity (PWMH), deep white matter hyperintensity (DWMH), cerebral microbleed (CMB), enlarged perivascular space (PVS), and lacunar infarction (LI), were identified, and CSVD burden was calculated. According to total CSVD MR marker score, cases were classified as mild, moderate, or severe. The mean FW and fractional anisotropy (FA) values were calculated using DTI images. Results The mean white matter FW was associated with the CSVD MR markers, including PWMH, DWMH, LI and PVS (P < 0.05). Moreover, age, hypertension, diabetes mellitus, and FW value were associated with total CSVD MR marker score (P < 0.05). Ordinal logistic regression analysis revealed that FW and age were independently associated with CSVD burden (P < 0.05). Finally, FW in white matter was associated with FA (r = –0.334, P < 0.001). Conclusion Extracellular fluid changes, assessed by DTI metrics of FW in white matter, were associated with CSVD markers and burden. An increased extracellular fluid volume in the white matter was associated with lower FA.
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Affiliation(s)
- Haiyuan Lan
- Department of Radiology, Lishui Hospital of Traditional Chinese Medicine affiliated Zhejiang Chinese Medical University, Lishui, China
| | - Xinjun Lei
- Department of Radiology, Lishui Hospital of Traditional Chinese Medicine affiliated Zhejiang Chinese Medical University, Lishui, China
| | - Zhihua Xu
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, China
- *Correspondence: Zhihua Xu,
| | - Songkuan Chen
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Wanfeng Gong
- Department of Radiology, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Yunqi Cai
- Department of Radiology, Lishui Hospital of Traditional Chinese Medicine affiliated Zhejiang Chinese Medical University, Lishui, China
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17
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Gao Y, Li D, Lin J, Thomas AM, Miao J, Chen D, Li S, Chu C. Cerebral small vessel disease: Pathological mechanisms and potential therapeutic targets. Front Aging Neurosci 2022; 14:961661. [PMID: 36034144 PMCID: PMC9412755 DOI: 10.3389/fnagi.2022.961661] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
Cerebral small vessel disease (CSVD) represents a diverse cluster of cerebrovascular diseases primarily affecting small arteries, capillaries, arterioles and venules. The diagnosis of CSVD relies on the identification of small subcortical infarcts, lacunes, white matter hyperintensities, perivascular spaces, and microbleeds using neuroimaging. CSVD is observed in 25% of strokes worldwide and is the most common pathology of cognitive decline and dementia in the elderly. Still, due to the poor understanding of pathophysiology in CSVD, there is not an effective preventative or therapeutic approach for CSVD. The most widely accepted approach to CSVD treatment is to mitigate vascular risk factors and adopt a healthier lifestyle. Thus, a deeper understanding of pathogenesis may foster more specific therapies. Here, we review the underlying mechanisms of pathological characteristics in CSVD development, with a focus on endothelial dysfunction, blood-brain barrier impairment and white matter change. We also describe inflammation in CSVD, whose role in contributing to CSVD pathology is gaining interest. Finally, we update the current treatments and preventative measures of CSVD, as well as discuss potential targets and novel strategies for CSVD treatment.
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Affiliation(s)
- Yue Gao
- Department of Neurointervention and Neurological Intensive Care, Dalian Municipal Central Hospital, Dalian, China
| | - Di Li
- Department of Neurointervention and Neurological Intensive Care, Dalian Municipal Central Hospital, Dalian, China
| | - Jianwen Lin
- Department of Neurology, Dalian Municipal Central Hospital, Dalian, China
| | - Aline M. Thomas
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institution, Baltimore, MD, United States
| | - Jianyu Miao
- Department of Neurology, Dalian Municipal Central Hospital, Dalian, China
| | - Dong Chen
- Department of Neurosurgery, Dalian Municipal Central Hospital, Dalian, China
| | - Shen Li
- Department of Neurology and Psychiatry, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Chengyan Chu
- Department of Neurology, Dalian Municipal Central Hospital, Dalian, China
- *Correspondence: Chengyan Chu,
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18
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Zhang L, Gao F, Zhang Y, Hu P, Yao Y, Zhang Q, He Y, Shang Q, Zhang Y. Analysis of risk factors for the development of cognitive dysfunction in patients with cerebral small vessel disease and the construction of a predictive model. Front Neurol 2022; 13:944205. [PMID: 36034271 PMCID: PMC9403715 DOI: 10.3389/fneur.2022.944205] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 07/22/2022] [Indexed: 12/18/2022] Open
Abstract
Background Cognitive dysfunction in cerebral small vessel disease (CSVD) is a common cause of vascular dementia. The purpose of this study was to find independent risk factors for the development of cognitive dysfunction in patients with CSVD and establish a risk prediction model, in order to provide a reference for clinical diagnosis and treatment of such patients. Methods In this study, clinical data of patients with CSVD admitted to the Department of Neurology in Gansu Provincial Hospital from December 2019 to December 2021 were collected, and 159 patients were finally included after strict screening according to the inclusion and exclusion criteria. There were 43 patients with normal function and 116 patients with cerebral small vessel disease cognitive impairment (CSVDCI). The logistic multivariable regression model was used to screen out the independent risk factors of cognitive dysfunction in patients with CSVD, and the nomogram of cognitive dysfunction in patients with CSVD was constructed based on the results of the logistic multivariable regression analysis. Finally, the accuracy of the prediction model was evaluated by C-index, calibration curve, receiver operating characteristic (ROC) curve, and decision curve analysis (DCA). Results The results of multivariable logistic regression analysis showed that hypertension (OR = 2.683, 95% CI 1.119–6.432, P = 0.027), homocysteine (Hcy) (OR = 1.083, 95% CI 1.026–1.143, P = 0.004), total CSVD MRI Score (OR = 1.593, 95% CI 1.025–2.475, P = 0.039) and years of schooling (OR = 0.883, 95% CI 0.798–0.978, P = 0.017) were independent risk factors for the development of cognitive dysfunction in patients with CSVD. The C-index of this prediction model was 0.806 (95% CI 0.735–0.877), and the calibration curve, ROC curve, and DCA curve all showed good predictive power in the nomogram. Conclusions The nomogram constructed in this study has high accuracy and clinical utility in predicting the occurrence of cognitive dysfunction in patients with CSVD. For patients with CSVD with the above risk factors, active clinical intervention and prevention are required during clinical consultation and disease management to avoid cognitive impairment as much as possible.
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Affiliation(s)
- Le Zhang
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Lanzhou, China
- The Department of Neurology, Gansu Provincial Hospital, Lanzhou, China
| | - Fulin Gao
- The Department of Neurology, Gansu Provincial Hospital, Lanzhou, China
| | - Yamin Zhang
- The Department of Neurology, Gansu Provincial Hospital, Lanzhou, China
| | - Pengjuan Hu
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Lanzhou, China
- The Department of Neurology, Gansu Provincial Hospital, Lanzhou, China
| | - Yuping Yao
- The Department of Neurology, Gansu Provincial Hospital, Lanzhou, China
| | - Qingzhen Zhang
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Lanzhou, China
- The Department of Neurology, Gansu Provincial Hospital, Lanzhou, China
| | - Yan He
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Lanzhou, China
- The Department of Neurology, Gansu Provincial Hospital, Lanzhou, China
| | - Qianlan Shang
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Lanzhou, China
- The Department of Neurology, Gansu Provincial Hospital, Lanzhou, China
| | - Yi Zhang
- The Department of Neurology, Gansu Provincial Hospital, Lanzhou, China
- *Correspondence: Yi Zhang
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19
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Hou L, Zhang S, Qi D, Jia T, Wang H, Zhang W, Wei S, Xue C, Wang P. Correlation between neutrophil/lymphocyte ratio and cognitive impairment in cerebral small vessel disease patients: A retrospective study. Front Neurol 2022; 13:925218. [PMID: 35989913 PMCID: PMC9391025 DOI: 10.3389/fneur.2022.925218] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background and objective The blood neutrophil/lymphocyte ratio (NLR) is an objective and convenient parameter of systemic inflammation. Elevated NLR is associated with an increased risk of mild cognitive impairment (CI) in the elderly. However, few data are available on the impact of the NLR on CI in patients with cerebral small vessel disease (CSVD). Methods A total of 66 CSVD subjects with CI and 81 CSVD subjects without CI were evaluated in this study. Clinical, laboratory, radiological, and cognitive parameters were collected. The NLR was obtained with the absolute neutrophil count being divided by the absolute lymphocyte count in fasting blood samples. Logistic regression analysis was performed to evaluate the factors associated with CI. Receiver operating characteristic curves were illustrated to predict factors associated with CI in patients with CSVD. Results The NLR of the CI group was significantly higher than that of subjects without CI (2.59 vs. 2.21, P = 0.003). In multivariate analysis, NLR was positively correlated to the CI (OR: 1.43, 95% CI: 1.05–1.96, P = 0.024). It was suggested that the optimum NLR cutoff point for CI was 1.89 with 69.7% sensitivity and 59.3% specificity. Subjects with NLR ≥ 1.89 showed higher possibilities of CI compared to those with NLR < 1.89 (OR: 3.38, 95% CI: 1.62–7.07). Conclusions Correlations were found between NLR and CI. Patients with CSVD who have higher NLR might have an increased risk of CI.
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Affiliation(s)
- Lan Hou
- Department of Neurology, Baoding No.1 Central Hospital, Baoding, China
- Baoding City Key Laboratory of Neurological Diseases, Baoding, China
| | - Shuhan Zhang
- Department of Neurology, Baoding No.1 Central Hospital, Baoding, China
| | - Dandan Qi
- Department of Neurology, Baoding No.1 Central Hospital, Baoding, China
| | - Tongle Jia
- Baoding City Key Laboratory of Neurological Diseases, Baoding, China
- Department of Neurosurgery, Baoding No.1 Central Hospital, Baoding, China
| | - Huan Wang
- Department of Neurology, Baoding No.1 Central Hospital, Baoding, China
| | - Wei Zhang
- Department of Neurology, Baoding No.1 Central Hospital, Baoding, China
| | - Shuyan Wei
- Department of Neurology, Baoding No.1 Central Hospital, Baoding, China
| | - Conglong Xue
- Department of General Surgery, Baoding No.1 Central Hospital, Baoding, China
| | - Pei Wang
- Department of Neurology, Baoding No.1 Central Hospital, Baoding, China
- Baoding City Key Laboratory of Neurological Diseases, Baoding, China
- *Correspondence: Pei Wang
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20
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The Underlying Role of the Glymphatic System and Meningeal Lymphatic Vessels in Cerebral Small Vessel Disease. Biomolecules 2022; 12:biom12060748. [PMID: 35740873 PMCID: PMC9221030 DOI: 10.3390/biom12060748] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/21/2022] [Accepted: 05/24/2022] [Indexed: 02/01/2023] Open
Abstract
There is a growing prevalence of vascular cognitive impairment (VCI) worldwide, and most research has suggested that cerebral small vessel disease (CSVD) is the main contributor to VCI. Several potential physiopathologic mechanisms have been proven to be involved in the process of CSVD, such as blood-brain barrier damage, small vessels stiffening, venous collagenosis, cerebral blood flow reduction, white matter rarefaction, chronic ischaemia, neuroinflammation, myelin damage, and subsequent neurodegeneration. However, there still is a limited overall understanding of the sequence and the relative importance of these mechanisms. The glymphatic system (GS) and meningeal lymphatic vessels (mLVs) are the analogs of the lymphatic system in the central nervous system (CNS). As such, these systems play critical roles in regulating cerebrospinal fluid (CSF) and interstitial fluid (ISF) transport, waste clearance, and, potentially, neuroinflammation. Accumulating evidence has suggested that the glymphatic and meningeal lymphatic vessels played vital roles in animal models of CSVD and patients with CSVD. Given the complexity of CSVD, it was significant to understand the underlying interaction between glymphatic and meningeal lymphatic transport with CSVD. Here, we provide a novel framework based on new advances in main four aspects, including vascular risk factors, potential mechanisms, clinical subtypes, and cognition, which aims to explain how the glymphatic system and meningeal lymphatic vessels contribute to the progression of CSVD and proposes a comprehensive insight into the novel therapeutic strategy of CSVD.
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21
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Jiang L, Cai X, Yao D, Jing J, Mei L, Yang Y, Li S, Jin A, Meng X, Li H, Wei T, Wang Y, Pan Y, Wang Y. Association of inflammatory markers with cerebral small vessel disease in community-based population. J Neuroinflammation 2022; 19:106. [PMID: 35513834 PMCID: PMC9072153 DOI: 10.1186/s12974-022-02468-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background This study investigated the relationships of neutrophil count (NC), neutrophil-to-lymphocyte ratio (NLR) and systemic immune-inflammation index (SII) with cerebral small vessel disease (CSVD). Methods A total of 3052 community-dwelling residents from the Poly-vasculaR Evaluation for Cognitive Impairment and vaScular Events (PRECISE) study were involved in this cross-sectional study. CSVD burden and imaging markers, including white matter hyperintensity (WMH), lacunes, cerebral microbleeds (CMBs) and enlarged perivascular spaces in basal ganglia (BG-EPVS), were assessed according to total CSVD burden score. The associations of NC, NLR and SII with CSVD and imaging markers were evaluated using logistic regression models. Furthermore, two-sample Mendelian randomization (MR) analysis was performed to investigate the genetically predicted effect of NC on CSVD. The prognostic performances of NC, NLR and SII for the presence of CSVD were assessed. Results At baseline, the mean age was 61.2 ± 6.7 years, and 53.5% of the participants were female. Higher NC was suggestively associated with increased total CSVD burden and modified total CSVD burden (Q4 vs. Q1: common odds ratio (cOR) 1.33, 95% CI 1.05–1.70; cOR 1.28, 95% CI 1.02–1.60) and marginally correlated with the presence of CSVD (OR 1.29, 95% CI 1.00–1.66). Furthermore, elevated NC was linked to a higher risk of lacune (OR 2.13, 95% CI 1.25–3.62) and moderate-to-severe BG-EPVS (OR 1.67, 95% CI 1.14–2.44). A greater NLR was related to moderate-to-severe BG-EPVS (OR 1.68, 95% CI 1.16–2.45). Individuals with a higher SII had an increased risk of modified WMH burden (OR 1.35, 95% CI 1.08–1.69) and moderate-to-severe BG-EPVS (OR 1.70, 95% CI 1.20–2.41). MR analysis showed that genetically predicted higher NC was associated with an increased risk of lacunar stroke (OR 1.20, 95% CI 1.04–1.39) and small vessel stroke (OR 1.21, 95% CI 1.06–1.38). The addition of NC to the basic model with traditional risk factors improved the predictive ability for the presence of CSVD, as validated by the net reclassification index and integrated discrimination index (all p < 0.05). Conclusions This community-based population study found a suggestive association between NC and CSVD, especially for BG-EPVS and lacune, and provided evidence supporting the prognostic significance of NC. Supplementary Information The online version contains supplementary material available at 10.1186/s12974-022-02468-0.
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Affiliation(s)
- Lingling Jiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
| | - Xueli Cai
- Department of Neurology, Lishui Hospital, Zhejiang University School of Medicine, Lishui, 323000, China
| | - Dongxiao Yao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
| | - Lerong Mei
- Cerebrovascular Research Lab, Lishui Hospital, Zhejiang University School of Medicine, Lishui, 323000, China
| | - Yingying Yang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
| | - Shan Li
- Cerebrovascular Research Lab, Lishui Hospital, Zhejiang University School of Medicine, Lishui, 323000, China
| | - Aoming Jin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
| | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
| | - Tiemin Wei
- Department of Cardiology, Lishui Hospital, Zhejiang University School of Medicine, Lishui, 323000, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China. .,China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China.
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, 100070, China. .,China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China.
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22
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Aktas G, Khalid A, Kurtkulagi O, Duman TT, Bilgin S, Kahveci G, Atak Tel BM, Sincer I, Gunes Y. Poorly controlled hypertension is associated with elevated serum uric acid to HDL-cholesterol ratio: A cross-sectional cohort study. Postgrad Med 2022; 134:297-302. [PMID: 35142235 DOI: 10.1080/00325481.2022.2039007] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES The diagnosis and follow up of Hypertension (HT) depends on the blood pressure measurements, which can be affected by several factors. In the present work, we aimed to explore the role of uric acid/HDL-cholesterol ratio (UHR) in HT and whether/or not it was associated with poor blood pressure control. METHODS In this retrospective cross-sectional cohort study, all the participants treated for hypertension and then followed up in the internal medicine clinics of our institution were enrolled. Hypertensive patients were grouped as either poorly or well-controlled hypertension groups, according to the suggestions of Joint National Committee VIII criteria and healthy volunteers were enrolled as control group. UHR of the study groups were compared. RESULTS Our Study cohort consisted of 535 subjects; 258 in the well-controlled HT group, 186 in the poorly controlled HT group, and 91 in the control group. Median UHR levels of the poorly controlled HT group (13(4-43) %) was significantly higher than well-controlled HT group 11 (4-22) %), and control group (8 (4-19) %), (p<0.001). UHR was correlated with systolic (r=0.33, p<0.001), and diastolic (r=0.28, p<0.001) BP. UHR level greater than 11% has 70% sensitivity and 60% specificity in predicting poor BP control (AUC: 0.73, p<0.001, 95%CI: 0.68-0.77). UHR was an independent risk factor for poor BP control in HT subjects and a unit elevation in UHR increased the risk of poorer BP control by 7.3 times (p<0.001, 95%CI: 3.9-13.63). CONCLUSION Assessment of UHR may be useful in HT patients since elevated UHR levels could be associated with poor blood pressure control in this population.
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Affiliation(s)
- Gulali Aktas
- Abant Izzet Baysal University Hospital, Department of Internal Medicine, Bolu, Turkey
| | - Atiqa Khalid
- Sahiwal Medical College affiliated with University of Health Sciences, Lahore, Pakistan
| | - Ozge Kurtkulagi
- Abant Izzet Baysal University Hospital, Department of Internal Medicine, Bolu, Turkey
| | | | - Satilmis Bilgin
- Abant Izzet Baysal University Hospital, Department of Internal Medicine, Bolu, Turkey
| | - Gizem Kahveci
- Abant Izzet Baysal University Hospital, Department of Internal Medicine, Bolu, Turkey
| | | | - Isa Sincer
- Abant Izzet Baysal University Hospital, Department of Cardiology, Bolu, Turkey
| | - Yilmaz Gunes
- Abant Izzet Baysal University Hospital, Department of Cardiology, Bolu, Turkey
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Libby P, Mallat Z, Weyand C. Immune And Inflammatory Mechanisms Mediate Cardiovascular Diseases From Head To Toe. Cardiovasc Res 2021; 117:2503-2505. [PMID: 34698765 DOI: 10.1093/cvr/cvab332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Practitioners have long recognized the involvement of inflammation in certain acute cardiovascular diseases such as endocarditis, myocarditis, and pericarditis. Attention to the participation of immune and inflammatory mechanisms in chronic cardiovascular diseases has generally lagged. Yet, these pathways contribute to a broad swath of clinically important cardiovascular conditions, both acute and chronic. Understanding of these complex mechanisms can aid specialists in cardiovascular research and practice immeasurably by providing new concepts and illuminating new diagnostic and therapeutic strategies. The collection of essays presented in this focused issue of Cardiovascular Research aims to promote this goal.
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Affiliation(s)
- Peter Libby
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ziad Mallat
- Division of Cardiovascular Medicine, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Cornelia Weyand
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
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