Abstract
Previous studies demonstrated that diabetic stroke patients had a poor prognosis and excess complement system activation in the peripheral blood. In this study, the association of serum complement levels with the prognosis of diabetic stroke was examined. Patients with acute ischemic stroke were recruited and were divided into two groups according to their history of diabetes. Baseline data on the admission, including C3 and C4 were collected. Neurologic function at discharge was the primary outcome and was quantified by the National Institutes of Health Stroke Scale (NIHSS). A total of 426 patients with acute ischemic stroke (116 diabetic strokes and 310 non-diabetic strokes) were recruited in this study. There were significant differences between the two groups in hypertension, coronary disease, triglyceride, high-density lipoprotein cholesterol, fasting blood sugar, C4, and mortality rates. Furthermore, the values of complement protein levels were divided into tertiles. In the diabetic stroke group, serum C4 level at the acute phase in the upper third was independently associated with NIHSS score at discharge and concurrent infection. These associations were not significant in non-diabetic stroke. High serum C4 level at admission, as a unique significant predictor, was associated with unfavorable clinical outcomes in the diabetic stroke, independently of traditional risk factors.
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Original data of the present study are available from the corresponding author upon reasonable request.
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Acknowledgements
We would like to thank Prof. Xingshun Xu for his valuable comments on this manuscript.
Funding
This work was supported by the grants from The Natural Science Foundation of the Jiangsu Higher Education Institutions of China (20KJB320021), National Key R&D Program of China (2017YFC0110304), and Provincial Key R & D projects of Jiangsu (BE2019666).
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Ximeng Zhang, Yi Yang, and Jianqiang Ni designed the study. Ximeng Zhang, Jun Yin, Kai Shao, Wei Liu, Yiqing Wang, Shanshan Diao, Shicun Huang, and Qun Xue evaluated the subjects and collected the data. Le Yang and Yi Yang analyzed the data. Ximeng Zhang, Jun Yin, and Kai Shao wrote the initial draft, with Jianqiang Ni and Yi Yang participating in revising the manuscript.
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This study involving human participants was reviewed and approved by the Institutional Review Board of The First Affiliated Hospital of Soochow University. The procedures used in this study adhere to the tenets of the Declaration of Helsinki. The experiments comply with the current laws of the country in which they were performed. All patients gave informed consent.
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Zhang, X., Yin, J., Shao, K. et al. High serum complement component C4 as a unique predictor of unfavorable outcomes in diabetic stroke. Metab Brain Dis 36, 2313–2322 (2021). https://doi.org/10.1007/s11011-021-00834-0
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DOI: https://doi.org/10.1007/s11011-021-00834-0