This study explored the value of
cystatin C (CysC) in predicting
stroke recurrence in patients with
acute ischemic stroke.Methods and Results:This was a post hoc analysis of the China
Antihypertensive Trial in
Acute Ischemic Stroke (CATIS) on 3,474
acute ischemic stroke patients with documented serum CysC and
high-sensitivity C-reactive protein (
hsCRP) concentrations. Study outcomes included
stroke recurrence and combined vascular events within 2 years after
stroke. In
stroke patients with higher (i.e., ≥4.8ng/mL), but not lower,
hsCRP concentrations, a higher CysC concentration (i.e., ≥0.78 mg/L) was associated with a 2.48-fold increase in the risk of recurrent
stroke (95% confidence interval [CI] 1.37-4.51; P=0.003) and a 2.04-fold increase in the risk of vascular events (95% CI 1.27-3.28; P=0.003). Serum
hsCRP concentrations significantly modified the association of serum CysC with recurrent
stroke (Pinteraction=0.001) and vascular events (Pinteraction=0.007). Moreover, CysC may improve reclassification of
stroke recurrence (net reclassification improvement [NRI] 42.9%, P=0.001; integrated discrimination improvement [IDI] 1.2%, P=0.001) and vascular events (NRI 35.8%, P=0.001; IDI 1.1%, P=0.004).
CONCLUSIONS: In
ischemic stroke patients with high
hsCRP concentrations, higher CysC concentrations increased the risk of
stroke recurrence and vascular events. This indicates that the predictive value of CysC on
stroke recurrence may depend on the
inflammation status of patients.