title: Biomarkers to predict clinical progression in small vessel disease strokes: prognostic role of albuminuria and oxidized LDL cholesterol.
abstract: OBJECTIVE
  Clinical progression in lacunar strokes (LS) is an unpredictable and fearful complication. Endothelial dysfunction (ED) is believed to be the first step in the pathophysiology of LS therefore we aimed to analyze the association of three markers of ED: albuminuria, von Willebrand factor (vWF), and oxidized LDL cholesterol (ox-LDL) with LS progression.
  
  
  METHODS
  From December 2007 to December 2010, 127 LS patients admitted within 6 h of symptom onset were prospectively assessed. Progression was defined as initial NIHSS score worsening ≥4 points within the first 72 h. Analysis of vWF and ox-LDL was done at admission. Albuminuria was measured in the first morning spot urine. Association between 3 biomarkers and progression was tested using logistic regression analysis. Other clinical variables of interest were also studied. Discriminative power was analyzed with a receiver operator curve.
  
  
  RESULTS
  Twenty-two patients (17.3%) progressed. Progression was associated with worse outcome at 90 days. Albuminuria and ox-LDL were associated in univariate analysis; vWF was not. Adjusted OR were: ox-LDL [OR: 1.03; 95% CI: 1.01-1.07, p=0.019], albuminuria [OR: 2.07; 95% CI: 1.04-4.13, p=0.039]. Association was linear without a cut-off point. Clinical variables were not associated with progression. The model including albuminuria and ox-LDL had a good predictive value [AUC: 0.80 [0.70-0.89)].
  
  
  CONCLUSIONS
  Albuminuria and ox-LDL levels are independently associated with higher risk of progression in LS. The lack of reliable clinical predictors makes biomarker research a priority to improve progression detection in this subtype of ischemic strokes.
authors.affiliation: Neurology Department, Neurovascular Research, Program of Research on Inflammatory and Cardiovascular Disorders, Municipal Institute for Medical Research, Passeig Marítim 25-29, 08003 Barcelona, Spain. Ecuadrado@hospitaldelmar.cat
authors.forename: Elisa
authors.initials: E
authors.lastname: Cuadrado-Godia
authors.forename: Angel
authors.initials: A
authors.lastname: Ois
authors.forename: Eva
authors.initials: E
authors.lastname: Garcia-Ramallo
authors.forename: Eva
authors.initials: E
authors.lastname: Giralt
authors.forename: Sara
authors.initials: S
authors.lastname: Jimena
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Rubio
authors.forename: Ana
authors.initials: A
authors.lastname: Rodríguez-Campello
authors.forename: Jordi
authors.initials: J
authors.lastname: Jiménez-Conde
authors.forename: Jaume
authors.initials: J
authors.lastname: Roquer
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000175:diagnosis*; D015415:Biomarkers / Q000097:blood*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008077:Lipoproteins, LDL / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D059409:Stroke, Lacunar / Q000097:blood* / Q000503:physiopathology* / Q000652:urine; D014841:von Willebrand Factor / Q000032:analysis
chemical_list: D015415:Biomarkers; D008077:Lipoproteins, LDL; C099252:oxidized low density lipoprotein; D014841:von Willebrand Factor