Predictive and prognostic values of serum C1q/tumor necrosis factor-related protein 9 for first-ever ischemic stroke

 Useless. Didn't tell us how to get CTRP9 to a level that provides protection.  This is why I consider biomarkers useless, they predict, but do not prevent.

Predictive and prognostic values of serum C1q/tumor necrosis factor-related protein 9 for first-ever ischemic stroke

Yan-Qing Zhang^1,2Hai-Feng Zhang³Xiao-Gang Liu^4*Rong Li^5*

• ¹Department of Anesthesiology, University Town Hospital of Chongqing Medical University, Chongqing, China
• ²Department of Anesthesiology, The First Hospital, Shanxi Medical University, Taiyuan, China
• ³Department of Teaching and Experiment Center, Air Force Military Medical University, Xi’an, China
• ⁴The Key Laboratory of Biomedical Information Engineering of Ministry of Education of China, School of Life Science and Technology, Xi’an Jiaotong University, Xi'an, China
• ⁵Department of Geriatrics, Xijing Hospital, The Fourth Military Medical University, Xi’an, China

Background: The C1q/Tumor Necrosis Factor-related Protein 9 (CTRP9) is a relatively novel adipokine having showed protection on cerebrovascular system. However, its clinical values have not been well established. This work is to evaluate CTRP9 as predictors of onset risk and outcome of ischemic stroke.

Methods: One thousand one hundred and twenty-three patients undergoing first-ever ischemic stroke and 835 controls were enrolled. Serum CTRP9 was determined within 24 h after the onset. One thousand and twenty-six patients were successfully followed up for all-cause and cardiovascular deaths. Stepwise regression was conducted to screen the independent factors of stroke onset in the whole sample and mortality in the patient subgroup. Survival curves were plotted to evaluate the effect of baseline serum CTRP9 on 3-year all-cause and cardiovascular mortalities of stroke patients.

Results: At baseline, prevalence of first-ever onset of ischemic stroke in high CTRP9 group was significantly lower than that in low CTRP9 group (p < 0.05) in non-hyperlipidemic subjects. Accumulative all-cause and cardiovascular mortality of patients with high baseline CTRP9 was significantly lower for the first year post stroke onset (p < 0.05). Baseline low CTRP9 was one of the independent risk factors of 3-year all-cause mortality (p < 0.05) of ischemic stroke patients.

Conclusion: High serum CTRP9 exerted protection against first-ever onset of ischemic stroke in non-hyperlipidemic subjects, and also protected general stroke patients against all-cause and cardiovascular mortality at least 1 year post stroke onset. Our findings in this study may pinpoint both the predictive and prognostic values of CTRP9 as a promising biomarker.

1 Introduction

Ischemic stroke, also known as cerebral infarction, refers to localized ischemic softening or necrosis of brain parenchyma caused by cerebral circulation disorders, secondary ischemia, and hypoxic pathological changes (1). Stroke represents the second leading cause of death in the world only after ischemic heart disease, and is the leading cause of disability in adults (2). Ischemic stroke accounts for about 87% of all strokes (3). Therefore, it is important to identify high-risk individuals in the elders especially those already with some predisposing factors.

It has been well-established that adipose tissue has active secretory functions (4). It secretes various adipokines involved in many pathophysiological processes, such as inflammation, energy metabolism, apoptosis, and aging (4–6). Among the adipokines, leptin, adiponectin, and the C1q/Tumor Necrosis Factor-related Proteins (CTRPs) typically play active roles in energy metabolism regulation, vasomotion modulation, platelet activation, and inflammation reaction (7–9). Substantial evidence supports CTRP9 as a beneficial molecule against obesity-related cardiovascular diseases and glycolipid disorders (7, 10). However, the clinical significance of CTRP9 in the onset risk and prognosis of ischemic stroke has not been well explored. Identification of new biomarkers would facilitate early or ultra-early recognition of high-risk patients of ischemic stroke or unfavorable clinical events, and thus introduce better management of patients. Discovery of protective adipokines against unfavorable outcomes of stroke patients may provide novel target and pathway for novel interventions.