Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China (P.Y., Z.Z., Y. Zang, X.B., T.X., C.Z., A.W., H.P., D.G., X.Z., T.X., Y. Zhang, X.Z.).
Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (Z.Z., D.G., J.C., J.H.).
Stroke. 2021 Mar;52(3):868-877. doi: 10.1161/STROKEAHA.120.031715. Epub 2021 Feb 1.
Complement C3 has been implicated in inflammation and ischemia/reperfusion injury, but its impact on the prognosis of ischemic stroke remains unclear. Aim of this study was to prospectively investigate the association between serum complement C3 and adverse clinical outcomes after ischemic stroke.
We measured serum complement C3 levels for 3474 patients with ischemic stroke in 26 participating hospitals and collected data of clinical outcomes at 3 months after ischemic stroke. The primary outcome was composite outcome of death and major disability (modified Rankin Scale score ≥3) at 3 months after stroke onset and secondary outcomes included major disability, death, and vascular events.
During 3 months of follow-up, 866 participants (25.4%) developed primary outcome. After multivariate adjustment, elevated serum complement C3 levels were associated with increased risk of primary outcome (odds ratio, 1.30 [95% CI, 1.02-1.65]; =0.038) when 2 extreme tertiles were compared. Each SD increase of log-transformed complement C3 was associated with 13% (95% CI, 2%-25%) increased risk of primary outcome. Multivariable-adjusted spline regression model showed a linear relationship between serum complement C3 and the risk of primary outcome (=0.022). Addition of serum complement C3 to conventional risk factors significantly improved the risk prediction of primary outcome (net reclassification index: 8.87%, =0.028; integrated discrimination index: 0.19%, =0.029).
High serum complement C3 levels at baseline were associated with increased risks of adverse clinical outcomes at 3 months after ischemic stroke, suggesting that serum complement C3 may be a valuable prognostic biomarker for ischemic stroke.
补体 C3 已被牵涉到炎症和缺血/再灌注损伤中，但它对缺血性脑卒中预后的影响仍不清楚。本研究旨在前瞻性地研究血清补体 C3 与缺血性脑卒中后不良临床结局之间的关系。
我们测量了 26 家参与医院的 3474 例缺血性脑卒中患者的血清补体 C3 水平，并收集了缺血性脑卒中发病后 3 个月的临床结局数据。主要结局为卒中发病后 3 个月时的死亡和主要残疾（改良 Rankin 量表评分≥3）复合结局，次要结局包括主要残疾、死亡和血管事件。
在 3 个月的随访期间，866 名参与者（25.4%）发生了主要结局。在多变量调整后，与最低 2 个三分位相比，较高的血清补体 C3 水平与主要结局风险增加相关（比值比，1.30[95%CI，1.02-1.65]；=0.038）。对 log 转换后的补体 C3 进行 SD 增加，与主要结局风险增加 13%（95%CI，2%-25%）相关。多变量调整的样条回归模型显示，血清补体 C3 与主要结局风险之间呈线性关系（=0.022）。将血清补体 C3 添加到常规危险因素中可显著改善主要结局的风险预测（净重新分类指数：8.87%，=0.028；综合判别指数：0.19%，=0.029）。
基线时较高的血清补体 C3 水平与缺血性脑卒中后 3 个月的不良临床结局风险增加相关，提示血清补体 C3 可能是缺血性脑卒中的一个有价值的预后生物标志物。
