title: Decreased serum PCSK9 levels after ischaemic stroke predict worse outcomes.
abstract: BACKGROUND
  Soluble mediators have been investigated to predict the prognosis of acute ischaemic stroke (AIS). Among them, proprotein convertase subtilisin/kexin type 9 (PCSK9) might have both clinical and pathophysiological relevance.
  
  
  METHODS
  All available serum samples from a cohort of patients with first AIS (n = 72) were tested for PCSK9 and included in this substudy analysis. The primary endpoint investigated the predictive value of early PCSK9 level variations (ΔPCSK9) from AIS onset to day 7 or from day 1 to day 7, towards a 90-day outcome by modified Rankin Scale (mRS). The secondary endpoint explored the association between ΔPCSK9 and the risk of major adverse cardiovascular events (MACEs).
  
  
  RESULTS
  Decreased serum PCSK9 levels at days 1 and 7 were associated with poor clinical outcomes at day 90. At the cut-off point identified by ROC curve analysis (-61·28 ng/mL), ΔPCSK9 day 7-day 1 predicted a poor mRS at day 90 after AIS. ΔPCSK9 day 7-day 1 ≤ -61·28 ng/mL was associated with an increased rate of MACEs.
  
  
  CONCLUSIONS
  A decrease in PCSK9 levels was a predictor for poor outcome and increased MACEs after AIS. Additional studies targeting post-AIS PCSK9 levels and activity are required to clarify the prognostic and pathophysiological relevance of PCSK9 after AIS.
authors.affiliation: First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Liberale
authors.affiliation: First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.|IRCCS AOU San Martino - IST, Genoa, Italy.|Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Montecucco
authors.affiliation: Department of Biological, Psychiatric and Psychological Science, Azienda Ospedaliera-Universitaria, Ferrara, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Casetta
authors.affiliation: Istitute for Maternal and Child Health 'IRCCS Burlo Garofolo', Trieste, Italy.
authors.forename: Silva
authors.initials: S
authors.lastname: Seraceni
authors.affiliation: Section of Medical Biochemistry, Molecular Biology and Genetics, Department of Biomedical and Specialist Surgical Sciences, University of Ferrara, Ferrara, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Trentini
authors.affiliation: Department of Biological, Psychiatric and Psychological Science, Azienda Ospedaliera-Universitaria, Ferrara, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Padroni
authors.affiliation: First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.|IRCCS AOU San Martino - IST, Genoa, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Dallegri
authors.affiliation: Division of Cardiology, Department of Medical Specialties, Foundation for Medical Researches, University of Geneva, Geneva, Switzerland.
authors.forename: François
authors.initials: F
authors.lastname: Mach
authors.affiliation: Neuroradiology Unit, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Fainardi
authors.affiliation: First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.
authors.forename: Federico
authors.identifier: http://orcid.org/0000-0003-2957-4078
authors.initials: F
authors.lastname: Carbone
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D010865:Pilot Projects; D011379:Prognosis; D000071449:Proprotein Convertase 9 / Q000097:blood*; D011446:Prospective Studies; D012372:ROC Curve; D012720:Severity of Illness Index; D020521:Stroke / Q000097:blood* / Q000503:physiopathology
chemical_list: C472125:PCSK9 protein, human; D000071449:Proprotein Convertase 9
keywords: Cholesterol; PCSK9; injury; ischaemic stroke