Angiopoietin-like protein 4 and clinical outcomes in ischemic stroke patients

Background and aims Angiopoietin-like protein 4 (ANGPTL-4) had been reported to be associated with the risk of ischemic stroke, but its prognostic value remained unclear. The aim of this study was to investigate the association between plasma ANGPTL-4 concentrations and prognosis of ischemic stroke. Methods Baseline plasma ANGPTL-4 concentrations were measured in 3379 acute ischemic stroke patients. The primary outcome was a combination of death or major disability (modified Rankin Scale score, ≥3) at 3 months after ischemic stroke, and secondary outcomes included major disability, death, stroke recurrence and vascular events. Results At 3 months after ischemic stroke, 850 (26.16%) participants experienced major disability or died (750 major disabilities and 100 deaths). After adjusting for important covariates, odds ratios for the highest tertile of plasma ANGPTL-4 concentrations were 1.59(1.22-2.06) for primary outcome, 1.53(1.18-1.97) for major disability and 2.03(1.03-4.00) for death when compared to the lowest tertile of plasma ANGPTL-4 concentrations. For 1-SD increase of log-ANGPTL-4 concentrations (0.44 ng/ml), the adjusted odds ratios were 1.24(1.11-1.38), 1.14(1.03-1.27) and 1.72(1.32-2.23), respectively. Adding ANGPTL-4 to a model containing conventional risk factors improved risk prediction for composite outcome of death and major disability (net reclassification improvement index=11.36%, p =0.014; integrated discrimination improvement=0.22%, p =0.033). There were no significant associations between plasma ANGPTL-4 concentrations and risks of stroke recurrence and vascular events. Conclusion Higher plasma ANGPTL-4 concentration was associated with poor prognosis in acute ischemic stroke patients, suggesting that ANGPTL-4 might be a prognostic marker for ischemic stroke.