Affiliations: [a]
Department of Neurology, National Centre for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| [b]
Department of Neurology, First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| [c]
Neurodegenerative Disorder Research Centre and Institute on Aging and Brain Disorders, University of Science and Technology of China, Hefei, China
Correspondence:
[*]
Correspondence to: Xin Cheng, MD, PhD, Department of Neurology, Huashan Hospital Fudan University, 12
Wulumuqi Zhong Road, Shanghai, 200040 P. R. China. Tel.: +86 21 52887145; E-mail: chengxin@fudan.edu.cn and Ya Su, MD, Department of Neurology, Huashan Hospital Fudan University, 12 WulumuqiZhong Road, Shanghai,
200040 P. R. China. Tel.: +86 21 52887145; Fax:+86 21 52887145; E-mail: christsum1990@163.com.
Abstract: Background:Neuroinflammation is a major cause of secondary brain injury in intracerebral hemorrhage (ICH). To date, the prognostic value of YKL-40 (chitinase-3-like-1 protein), a biomarker of neuroinflammation, in cerebral amyloid angiopathy-related intracerebral hemorrhage (CAA-ICH) remains undiscovered. Objective:To evaluate the relationships between serum YKL-40 and CAA-ICH recurrence. Methods:Clinical and imaging information of 68 first-onset probable CAA-ICH cases and 95 controls were collected at baseline. Serum YKL-40 was measured by Luminex assay. Cox proportional hazards model was used to analyze the associations between YKL-40 level and CAA-ICH recurrence. Results:Serum YKL-40 level was significantly higher in CAA-ICH cases than healthy controls (median [interquartile range, IQR], 46.1 [19.8, 93.4] versus 24.4 [13.9, 59.0] ng/mL, p = 0.004). Higher level of YKL-40 predicted increased risk of CAA-ICH recurrence adjusted for age, ICH volume and enlarged perivascular space score (ePVS) (above versus below 115.5 ng/ml, adjusted hazard ratios 4.721, 95% confidence intervals 1.829–12.189, p = 0.001) within a median follow-up period of 2.4 years. Adding YKL-40 to a model of only MRI imaging markers including ICH volume and ePVS score improved the discriminatory power (concordance index from 0.707 to 0.772, p = 0.001) and the reclassification power (net reclassification improvement 28.4%; integrated discrimination index 11.0%). Conclusions:Serum YKL-40 level might be a candidate prognostic biomarker for CAA-ICH recurrence.
