title: Prognostic value of plasma chitotriosidase activity in acute stroke patients.
abstract: OBJECTIVE
  Chitotriosidase, a component of innate immunity, constitutes a sensitive parameter of macrophage activation and its elevated plasma activity reflects an inflammatory response. Given the deleterious effects of inflammation in brain ischemia, we aimed to assess the prognostic value of chitotriosidase activity in acute stroke patients.
  
  
  METHODS
  The study comprised 159 acute stroke patients and 51 age-matched controls. Plasma chitotriosidase activity was serially determined by fluorometric assay. Short-term neurological outcome was determined at 48 h and functional outcome at three-months. Predictors of neurological and functional outcome were determined via multivariate analysis, and the additional predictive value of chitotriosidase was tested with the Integrated Discrimination Index and the Net Reclassification Improvement.
  
  
  RESULTS
  Stroke patients showed increased levels of baseline chitotriosidase activity compared to controls [114·2 (74·65-182·95) nmol/ml/h vs. 54·4 (32·7-76·4); P < 0·0001]. Chitotriosidase activity (<118·75) was found to be an independent predictor of neurological improvement at 48 h (odds ratio: 3·25; 95% confidence interval: 1·54-6·85; P=0·002), and the addition of plasma chitotriosidase activity showed a better prediction of improvement at 48 h (Integrated Discrimination Index=5·7%, Net Reclassification Improvement=11·6%, P<0·05) over the predictive model constituted only with clinical information. Although patients disabled at three-months showed higher baseline chitotriosidase levels, it was not an independent predictor of long-term disability.
  
  
  CONCLUSIONS
  Baseline chitotriosidase activity in acute stroke patients treated with tissue plasminogen activator (tPA) may constitute a prognostic predictor of short-term outcome, adding a moderate additional predictive value. Our results underline the deleterious role of inflammation in acute stroke patients.
authors.affiliation: Neurovascular Research Laboratory, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Bustamante
authors.forename: Carmen
authors.initials: C
authors.lastname: Dominguez
authors.forename: Víctor
authors.initials: V
authors.lastname: Rodriguez-Sureda
authors.forename: Angel
authors.initials: A
authors.lastname: Vilches
authors.forename: Ana
authors.initials: A
authors.lastname: Penalba
authors.forename: Dolors
authors.initials: D
authors.lastname: Giralt
authors.forename: Teresa
authors.initials: T
authors.lastname: García-Berrocoso
authors.forename: Victor
authors.initials: V
authors.lastname: Llombart
authors.forename: Alan
authors.initials: A
authors.lastname: Flores
authors.forename: Marta
authors.initials: M
authors.lastname: Rubiera
authors.forename: Carlos
authors.initials: C
authors.lastname: Molina
authors.forename: José
authors.initials: J
authors.lastname: Alvarez-Sabín
authors.forename: Joan
authors.initials: J
authors.lastname: Montaner
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D006596:Hexosaminidases / Q000097:blood*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D020521:Stroke / Q000097:blood* / Q000175:diagnosis / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D006596:Hexosaminidases; C086400:chitotriosidase
keywords: biomarkers; chitotriosidase; inflammation; ischemic stroke; prognosis