YKL-40: a potential prognostic predictor of one-year clinical outcomes in patients with acute ischemic stroke

Abstract YKL-40 mediates vascular inflammation and plays a crucial role in the pathogenesis of acute ischemic stroke (AIS). Previous studies have identified YKL-40 as a potential diagnostic biomarker for AIS. However, in patients with AIS, the effects of YKL-40 on long-term clinical outcomes including poor clinical outcome, all-cause mortality, and stroke recurrence remained elusive.The purpose of this study was to explore the association between serum YKL-40 at admission and one-year clinical outcomes in AIS patients. In this prospective cohort study, a total of 1002 participants out of 1361 AIS patients from two centers were included for current analysis. Serum YKL-40 concentrations were measured via enzyme-linked immunosorbent assay. Multivariable logistic or Cox regression were performed to explore the independent association of YKL-40 with one-year clinical outcomes, including poor outcome (modified Rankin Scale of 3-6), all-cause mortality, and recurrent stroke. C-statistic, net reclassification index (NRI) and integrated discrimination improvement (IDI) were calculated to evaluate the discriminatoryand predictive power of YKL-40 when added to conventional model. Compared with the first quartile of YKL-40, the adjusted odds ratios or hazard ratios (95% CI) of the fourth quartile was 3.032 (1.627-5.650) for poor outcome, 2.886 (1.320-6.308) for all-cause mortality and 1.694 (0.906-3.169) for recurrent stroke. The addition of serum YKL-40 to conventional model significantly improved reclassification for poor outcome (NRI 0.053, P = 0.031; IDI 0.018, P = 0.001) and all-cause mortality (NRI 0.162, P = 0.036). In conclusion, elevated serum YKL-40 at baseline might be independently associated with one-year poor outcome and all-cause mortality but not stroke recurrence among Chinese AIS patients, suggesting that YKL-40 can potentially serve as a valuable prognosticbiomarker for AIS.