Plasma Human Cartilage Glycoprotein‐39 Is Associated With the Prognosis of Acute Ischemic Stroke

BACKGROUND: To evaluate the prognostic value of plasma YKL‐40 (human cartilage glycoprotein‐39) for acute ischemic stroke. METHODS AND RESULTS: We measured plasma YKL‐40 levels in 3377 participants from CATIS (China Antihypertensive Trial in Acute Ischemic Stroke). Study outcome data on death, major disability (modified Rankin Scale score ≥3), and vascular diseases were collected at 3 months after stroke onset. The primary outcome was defined as a combination of death and major disability. During the 3‐month follow‐up, 828 participants (24.5%) experienced major disability or died. After multivariate adjustment, the highest YKL‐40 quartile was associated with an increased risk of the primary outcome (odds ratio, 1.426 [95% CI, 1.105–1.839]; P (trend)=0.01) compared with the lowest quartile. Each SD increase in log‐transformed YKL‐40 level was associated with a 15.5% (95% CI, 5.6–26.3%) increased risk of the primary outcome. The multivariable‐adjusted spline regression models showed a linear dose–response relationship between YKL‐40 and clinical outcomes. Adding YKL‐40 to a model containing conventional risk factors significantly improved the reclassification power for the primary outcome (net reclassification improvement: 15.61%, P<0.001; integrated discrimination index: 0.37%, P=0.004) and marginally significantly improved the discriminatory power for the primary outcome (area under the receiver operating characteristic curve improved by 0.003, P=0.099). CONCLUSIONS: A higher YKL‐40 level in the acute phase of ischemic stroke was associated with an increased risk of mortality and major disability at 3 months after stroke, indicating that YKL‐40 may play an important role as a prognostic marker of ischemic stroke. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01840072.