M'barek Lamia, Jin Aoming, Pan Yuesong, Lin Jinxi, Jiang Yong, Meng Xia, Wang Yongjun
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University.
China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University.
J Atheroscler Thromb. 2025 Apr 1;32(4):458-473. doi: 10.5551/jat.64984. Epub 2024 Oct 26.
D-dimer, lipoprotein (a) (Lp(a)), and high-sensitivity C-reactive protein (hs-CRP) are known predictors of vascular events; however, their impact on the stroke prognosis is unclear. This study used data from the Third China National Stroke Registry (CNSR-III) to assess their combined effect on functional disability and mortality after acute ischemic stroke (AIS).
In total, 9,450 adult patients with AIS were enrolled between August 2015 and March 2018. Patients were categorized based on a cutoff value for D-dimer, Lp(a), and hs-CRP in the plasma. Adverse outcomes included poor functional outcomes (modified Rankin Scale (mRS score ≥ 3)) and one- year all-cause mortality. Logistic and multivariate Cox regression analyses were performed to investigate the relationship between individual and combined biomarkers and adverse outcomes.
Patients with elevated levels of all three biomarkers had the highest odds of functional disability (OR adjusted: 2.01; 95% CI (1.47-2.74); P＜0.001) and mortality (HR adjusted: 2.93; 95% CI (1.55-5.33); P＜0.001). The combined biomarkers improved the predictive accuracy for disability (C-statistic 0.80 vs.0.79, P＜0.001) and mortality (C-statistic 0.79 vs.0.78, P=0.01).
Elevated D-dimer, Lp(a), and hs-CRP levels together increase the risk of functional disability and mortality one-year post-AIS more than any single biomarker.
D-二聚体、脂蛋白(a) [Lp(a)]和高敏C反应蛋白(hs-CRP)是已知的血管事件预测指标；然而，它们对卒中预后的影响尚不清楚。本研究利用第三次中国国家卒中登记研究（CNSR-III）的数据，评估它们对急性缺血性卒中（AIS）后功能残疾和死亡率的综合影响。
2015年8月至2018年3月期间，共纳入9450例成年AIS患者。根据血浆中D-二聚体、Lp(a)和hs-CRP的临界值对患者进行分类。不良结局包括功能结局不佳（改良Rankin量表[mRS评分≥3]）和一年全因死亡率。进行逻辑回归和多变量Cox回归分析，以研究单个和联合生物标志物与不良结局之间的关系。
所有三种生物标志物水平升高的患者发生功能残疾的几率最高（校正OR：2.01；95%CI[1.47-2.74]；P＜0.001）和死亡率最高（校正HR：2.93；95%CI[1.55-5.33]；P＜0.001）。联合生物标志物提高了对残疾（C统计量0.80对0.79，P＜0.001）和死亡率（C统计量0.79对0.78，P=0.01）的预测准确性。
与任何单一生物标志物相比，D-二聚体、Lp(a)和hs-CRP水平升高共同增加了AIS后一年功能残疾和死亡的风险。
