Mira Katan1, Yeseon P Moon2, Myunghee C Paik2, Beat Mueller2, Andreas Huber2, Ralph L Sacco2, Mitchell S V Elkind2. 1. From the Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY (M.K., Y.P.M., M.S.V.E.); Department of Neurology, University Hospital of Zurich, Zurich, Switzerland (M.K.); Department of Biostatistics (M.C.P.) and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Department of Internal Medicine and Laboratory Medicine, Medical University Clinic, Kantonsspital Aarau, Switzerland (B.M., A.H.); and Departments of Neurology (R.L.S.) and Public Health Sciences and Human Genetics (R.L.S.), Miller School of Medicine, University of Miami, Coral Gables, FL. mira.katan@usz.ch. 2. From the Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY (M.K., Y.P.M., M.S.V.E.); Department of Neurology, University Hospital of Zurich, Zurich, Switzerland (M.K.); Department of Biostatistics (M.C.P.) and Department of Epidemiology (M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Department of Internal Medicine and Laboratory Medicine, Medical University Clinic, Kantonsspital Aarau, Switzerland (B.M., A.H.); and Departments of Neurology (R.L.S.) and Public Health Sciences and Human Genetics (R.L.S.), Miller School of Medicine, University of Miami, Coral Gables, FL.
Abstract
BACKGROUND AND PURPOSE: Chronic infections and neuroendocrine dysfunction may be risk factors for ischemic stroke (IS). We hypothesized that selected blood biomarkers of infection (procalcitonin [PCT]), hypothalamic-pituitary-axis function (copeptin), and hemodynamic dysfunction (midregional proatrial natriuretic peptide [MRproANP]) are associated with incident IS risk in the multiethnic, urban Northern Manhattan Study (NOMAS) cohort. METHODS: A nested case-control study was performed among initially stroke-free participants. Cases were defined as first IS (n=172). We randomly selected controls among those who did not develop an event (n=344). We calculated Cox proportional hazards models with inverse probability weighting to estimate the association of blood biomarkers with risk of stroke after adjusting for demographic, behavioral, and medical risk factors. RESULTS: Those with PCT and MRproANP, but not copeptin, in the top quartile, compared with the lowest quartile, were associated with IS (for PCT adjusted hazard ratio [HR], 1.9; 95% confidence interval [CI], 1.0-3.8 and for MRproANP adjusted HR, 3.5; 95% CI, 1.6-7.5). The associations of PCT and MRproANP differed by stroke etiology; PCT levels in the top quartile were particularly associated with small vessel stroke (adjusted HR, 5.1; 95% CI, 1.4-18.7) and MRproANP levels with cardioembolic stroke (adjusted HR, 16.3; 95% CI, 3.7-70.9). CONCLUSIONS: Higher levels of PCT, a marker of infection, and MRproANP, a marker for hemodynamic stress, were independently associated with IS risk. PCT was specifically associated with small vessel and MRproANP with cardioembolic stroke risk. Further study is needed to validate these biomarkers and determine their significance in stroke risk prediction and prevention.
BACKGROUND AND PURPOSE:Chronic infections and neuroendocrine dysfunction may be risk factors for ischemic stroke (IS). We hypothesized that selected blood biomarkers of infection (procalcitonin [PCT]), hypothalamic-pituitary-axis function (copeptin), and hemodynamic dysfunction (midregional proatrial natriuretic peptide [MRproANP]) are associated with incident IS risk in the multiethnic, urban Northern Manhattan Study (NOMAS) cohort. METHODS: A nested case-control study was performed among initially stroke-free participants. Cases were defined as first IS (n=172). We randomly selected controls among those who did not develop an event (n=344). We calculated Cox proportional hazards models with inverse probability weighting to estimate the association of blood biomarkers with risk of stroke after adjusting for demographic, behavioral, and medical risk factors. RESULTS: Those with PCT and MRproANP, but not copeptin, in the top quartile, compared with the lowest quartile, were associated with IS (for PCT adjusted hazard ratio [HR], 1.9; 95% confidence interval [CI], 1.0-3.8 and for MRproANP adjusted HR, 3.5; 95% CI, 1.6-7.5). The associations of PCT and MRproANP differed by stroke etiology; PCT levels in the top quartile were particularly associated with small vessel stroke (adjusted HR, 5.1; 95% CI, 1.4-18.7) and MRproANP levels with cardioembolic stroke (adjusted HR, 16.3; 95% CI, 3.7-70.9). CONCLUSIONS: Higher levels of PCT, a marker of infection, and MRproANP, a marker for hemodynamic stress, were independently associated with IS risk. PCT was specifically associated with small vessel and MRproANP with cardioembolic stroke risk. Further study is needed to validate these biomarkers and determine their significance in stroke risk prediction and prevention.
Authors: Joachim Struck; Martina Strebelow; Sonja Tietz; Christine Alonso; Nils G Morgenthaler; Johannes G van der Hoeven; Peter Pickkers; Andreas Bergmann Journal: Clin Chem Date: 2009-07-02 Impact factor: 8.327
Authors: Mary Cushman; Suzanne E Judd; Virginia J Howard; Brett Kissela; Orlando M Gutiérrez; Nancy S Jenny; Ali Ahmed; Evan L Thacker; Neil A Zakai Journal: Stroke Date: 2014-04-22 Impact factor: 7.914
Authors: B Müller; K L Becker; H Schächinger; P R Rickenbacher; P R Huber; W Zimmerli; R Ritz Journal: Crit Care Med Date: 2000-04 Impact factor: 7.598
Authors: Gian Marco De Marchis; Mira Katan; Anja Weck; Felix Fluri; Christian Foerch; Oliver Findling; Philipp Schuetz; Daniela Buhl; Marwan El-Koussy; Henrik Gensicke; Marlen Seiler; Nils Morgenthaler; Heinrich P Mattle; Beat Mueller; Mirjam Christ-Crain; Marcel Arnold Journal: Neurology Date: 2013-03-06 Impact factor: 9.910
Authors: Ovidiu S Cotoi; Jonas Manjer; Bo Hedblad; Gunnar Engström; Olle Melander; Alexandru Schiopu Journal: BMC Med Date: 2013-08-13 Impact factor: 8.775
Authors: Mira Katan; Yeseon Moon; Arnold von Eckardstein; Kathartina Spanaus; Janet DeRosa; Jose Gutierrez; Charles DeCarli; Clinton Wright; Ralph Sacco; Mitchell Elkind Journal: Stroke Date: 2017-01-25 Impact factor: 7.914
Authors: J Banach; Ł Wołowiec; D Rogowicz; L Gackowska; I Kubiszewska; W Gilewski; J Michałkiewicz; W Sinkiewicz Journal: Dis Markers Date: 2018-08-28 Impact factor: 3.434
Authors: Benjamin Hotter; Sarah Hoffmann; Lena Ulm; Joan Montaner; Alejandro Bustamante; Christian Meisel; Andreas Meisel Journal: Neurol Neuroimmunol Neuroinflamm Date: 2020-02-25