title: Cardioembolic and small vessel disease stroke show differences in associations between systemic C3 levels and outcome.
abstract: BACKGROUND
  Activation of the complement system has been proposed to play a role in the pathophysiology of stroke. As the specific involvement of the complement proteins may be influenced by stroke etiology, we compared plasma C3 and C3a levels in patients with cardioembolic (CE) and small vessel disease (SVD) subtypes of ischemic stroke and control subjects and evaluated their association to outcome at three months and two years.
  
  
  RESULTS
  Plasma C3 and C3a levels in 79 CE and 79 SVD stroke patients, sampled within 10 days and at three months after stroke, and age- and sex-matched control subjects from The Sahlgrenska Academy Study on Ischemic Stroke were measured by ELISA. Functional outcome was assesed with modified Rankin Scale. In the CE group, plasma C3 levels were elevated only in the acute phase, whereas C3a was elevated at both time points. The follow-up phase plasma C3 levels in the upper third were associated with an increased risk of unfavorable outcome at three months (OR 7.12, CI 1.72-29.46, P = 0.007) as well as after two years (OR 8.25, CI 1.61-42.28, P = 0.011) after stroke. These associations withstand adjustment for age and sex. Conversely, three-month follow-up plasma C3a/C3 level ratios in the middle third were associated with favorable outcome after two years both in the univariate analysis (OR 0.19, CI 0.05-0.82, P = 0.026) and after adjustment for age and sex (OR 0.19, CI 0.04-0.88, P = 0.033). In the SVD group, plasma C3 and C3a levels were elevated at both time points but showed no significant associations with outcome.
  
  
  CONCLUSIONS
  Plasma C3 and C3a levels are elevated after CE and SVD stroke but show associations with outcome only in CE stroke.
authors: Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
authors: Anna
authors: A
authors: Stokowska
authors: Sandra
authors: S
authors: Olsson
authors: Lukas
authors: L
authors: Holmegaard
authors: Katarina
authors: K
authors: Jood
authors: Christian
authors: C
authors: Blomstrand
authors: Christina
authors: C
authors: Jern
authors: Marcela
authors: M
authors: Pekna
mesh_terms: D002097:C-Reactive Protein / Q000378:metabolism; D016022:Case-Control Studies; D003167:Complement Activation; D015926:Complement C3a / Q000378:metabolism*; D004617:Embolism / Q000097:blood* / Q000276:immunology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D055806:Microvessels / Q000473:pathology; D008875:Middle Aged; D015999:Multivariate Analysis; D020521:Stroke / Q000097:blood* / Q000276:immunology / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D015926:Complement C3a; D002097:C-Reactive Protein
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