Open AccessSoluble ST2 predicts outcome and hemorrhagic transformation after acute stroke
Author(s) -
Wolcott Zoe,
Batra Ayush,
Bevers Matthew B.,
Sastre Cristina,
Khoury Jane,
Sperling Matthew,
Meyer Brett C.,
Walsh Kyle B.,
Adeoye Opeolu,
Broderick Joseph P.,
Kimberly W. Taylor
Publication year - 2017
Publication title -
annals of clinical and translational neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.824
H-Index - 42
ISSN - 2328-9503
DOI - 10.1002/acn3.435
Subject(s) - medicine , modified rankin scale , biomarker , stroke (engine) , receiver operating characteristic , logistic regression , gastroenterology , intracerebral hemorrhage , acute stroke , ischemic stroke , mechanical engineering , biochemistry , chemistry , tissue plasminogen activator , engineering , ischemia , subarachnoid hemorrhage
Objective ST 2 is a member of the toll‐like receptor superfamily that can alter inflammatory signaling of helper T‐cells. We investigated whether soluble ST 2 ( sST 2) could independently predict outcome and hemorrhagic transformation ( HT ) in the setting of stroke. Methods We measured sST 2 in patients enrolled in the Specialized Program of Translational Research in Acute Stroke ( SPOTRIAS ) network biomarker study. 646 patients had plasma samples collected at the time of hospital admission and 210 patients had a second sample collected 48 h after stroke onset. Functional outcome was assessed using the modified Rankin Scale ( mRS ), with good and poor outcomes defined as mRS 0‐2 and 3‐6, respectively. HT was classified using ECASS criteria. The relationships between sST 2, outcome, and HT were evaluated using multivariable logistic regression, Kaplan–Meier survival analysis and receiver operating characteristic curves. Results 646 patients were included in the analysis (mean age 69 years; 44% women), with a median NIHSS of 5 [ IQR : 2–12]. The median sST 2 level on hospital admission was 35.0 ng/ mL [ IQR : 25.7–49.8 ng/ mL ] and at 48 h it was 37.4 ng/ mL [ IQR 27.9–55.6 ng/ mL ]. sST 2 was independently associated with poor outcome ( OR : 2.77, 95% CI : 1.54–5.06; P = 0.003) and mortality ( OR : 3.56, 95% CI : 1.58–8.38, P = 0.001) after multivariable adjustment. Plasma sST 2 was also associated with hemorrhagic transformation after adjustment for traditional risk factors ( OR : 5.58, 95% CI : 1.40–37.44, P = 0.039). Interpretation Soluble ST 2 may serve as a prognostic biomarker for outcome and hemorrhagic transformation in patients with acute stroke. ST 2 may link neuroinflammation and secondary injury after stroke.