title: Activated leukocyte cell adhesion molecule and prognosis in acute ischemic stroke.
abstract: OBJECTIVE
  Biomarkers predicting mortality and functional outcome in stroke may be clinically helpful in identification of patients likely to benefit from intervention. Activated leukocyte cell adhesion molecule (ALCAM) is upregulated during neuroinflammation; we investigated whether ALCAM concentrations are associated with long-term mortality after ischemic stroke.
  
  
  METHODS
  In 244 patients with acute ischemic stroke (age 69±13 years), samples of ALCAM were obtained serially from presentation to Day 5 and after 6 months. Patients with overt ischemic heart disease and atrial fibrillation were excluded. The patients were followed for 47 months with all-cause and cardiovascular mortality as end points.
  
  
  RESULTS
  At follow-up, 72 patients (29%) had died, 43 due to cardiovascular causes. Patients with ALCAM in the fourth quartile (>46.8 ng/mL) at admission had a significantly poorer survival rate on univariate analysis (P<0.001); other time points did not add further but provided similar prognostic information. In multivariate analysis, after adjustment for age, stroke severity, C-reactive protein levels, troponin T levels, and heart and/or renal failure, ALCAM levels above the fourth quartile remained an independent predictor of long-term mortality (adjusted hazard ratio, 2.05; 95% CI, 1.11 to 3.76; P=0.021) and cardiovascular mortality (adjusted hazard ratio, 2.54; 95% CI, 1.06 to 6.07; P=0.028).
  
  
  CONCLUSIONS
  ALCAM levels measured at admission of acute ischemic stroke are associated with long-term mortality.
authors.affiliation: Room D1.2017, Research Institute for Internal, Medicine, Rikshospitalet, Sognsvannsveien 20, N-0027 Oslo, Norway.
authors.forename: Linda
authors.initials: L
authors.lastname: Smedbakken
authors.forename: Jesper K
authors.initials: JK
authors.lastname: Jensen
authors.forename: Jonas
authors.initials: J
authors.lastname: Hallén
authors.forename: Dan
authors.initials: D
authors.lastname: Atar
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
authors.forename: Bente
authors.initials: B
authors.lastname: Halvorsen
authors.forename: Pål
authors.initials: P
authors.lastname: Aukrust
authors.forename: Thor
authors.initials: T
authors.lastname: Ueland
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015703:Antigens, CD / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002545:Brain Ischemia / Q000097:blood* / Q000401:mortality*; D002097:C-Reactive Protein / Q000378:metabolism; D015816:Cell Adhesion Molecules, Neuronal / Q000097:blood*; D005260:Female; D005326:Fetal Proteins; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000097:blood* / Q000401:mortality*; D015996:Survival Rate; D013997:Time Factors; D020107:Troponin T / Q000097:blood; D015854:Up-Regulation; D020410:Activated-Leukocyte Cell Adhesion Molecule
chemical_list: D015703:Antigens, CD; D015415:Biomarkers; D002097:C-Reactive Protein; D015816:Cell Adhesion Molecules, Neuronal; D005326:Fetal Proteins; D020107:Troponin T; C105613:ALCAM protein, human; D020410:Activated-Leukocyte Cell Adhesion Molecule