Serum YKL-40 Levels Correlate with Infarct Volume, Stroke Severity, and Functional Outcome in Acute Ischemic Stroke Patients

Abstract

Background and PurposeYKL-40 is associated with various neurological disorders. However, circulatory YKL-40 levels early after onset of acute ischemic stroke (AIS) have not been systematically assessed. We aimed to identify the temporal changes and clinical usefulness of measuring serum YKL-40 immediately following AIS.MethodsSerum YKL-40 and C-reactive protein (CRP) levels were monitored over time in AIS patients (n = 105) and compared with those of stroke-free controls (n = 34). Infarct volume and stroke severity (National Institutes of Health Stroke Scale; NIHSS) were measured within 48 hours of symptom onset, and functional outcome (modified Rankin Scale; mRS) was measured 3 months after AIS.ResultsWithin 12 hours of symptom onset, levels of YKL-40 (251 vs. 41 ng/mL) and CRP (1.50 vs. 0.96 µg/mL) were elevated in AIS patients compared to controls. The power of YKL-40 for discriminating AIS patients from controls was superior to that of CRP (area under the curve 0.84 vs. 0.64) and YKL-40 (r = 0.26, P<0.001) but not CRP levels were correlated with mRS. On day 2 of admission (D2), YKL-40 levels correlated with infarct volume and NIHSS. High YKL-40 levels predicted poor functional outcome (odds ratio 5.73, P = 0.03). YKL-40 levels peaked on D2 and declined on D3, whereas CRP levels were highest on D3.ConclusionsOur results demonstrate serial changes in serum YKL-40 levels immediately following AIS and provide the first evidence that it is a valid indicator of AIS extent and an early predictor of functional outcome.

Elevation in circulating YKL-40 concentration in patients with cerebrovascular disease

“…In the present study, we demonstrated that the serum levels of YKL-40 were also elevated significantly (p<0.05) in Chinese patients with cerebrovascular disease as compared with the levels in the healthy control subjects and that the elevation did not significantly differ between ischemic stroke, hemorrhagic stroke and TIA (p>0.05). These observations support an association between circulating levels of YKL-40 and cerebrovascular disease subtypes and severities as previously reported [22].…”

Serum YKL-40 levels as a prognostic factor in patients with intracerebral hemorrhage

“…In agreement with the results in ischemic stroke, severe traumatic brain injury and aneurysmal subarachnoid hemorrhage [18][19][20][21][22], this study also verified higher serum YKL-40 levels in ICH. In addition, this study found that serum YKL-40 levels were highly associated with severity of hemorrhagic stroke.…”

“…However, serum YKL-40 levels did not improve the predictive value of NIHSS scores. Based on the previous results about acute ischemic stroke that serum YKL-40 levels are highly associated with infarct volume and stroke severity, as well as serum YKL-40 is identified as an independent predictor of long-term mortality and functional outcome [22], it is suggested that serum YKL-40 levels may also be associated with severity and clinical outcomes of ICH. In addition, this study only included such a group of patients with spontaneous basal ganglia hemorrhage.…”

“…YKL-40 levels are elevated in cerebrospinal fluid and serum after severe traumatic brain injury and aneurysmal subarachnoid hemorrhage [18,20,21]. The recent study has found that serum YKL-40 levels correlate with infarct volume, stroke severity, and functional outcome of patients with acute ischemic stroke [22]. To the best of our knowledge, the links between serum YKL-40 levels, disease severity, and clinical outcomes in ICH remain largely unknown.…”

Effect of carotid endarterectomy on brain damage markers

“…The authors concluded that YKL‐40 may be diagnostic/prognostic biomarker for cerebrovascular disease. According to Park et al , serum YKL‐40 levels associate with infarct volume, stroke severity, and functional outcome in acute ischemic stroke patients. Jiang et al observed that YKL‐40 is associated with inflammation and severity of intracerebral hemorrhage, and may independently predict long‐term clinical outcomes of intracerebral hemorrhage.…”