Serum Anti-NMDA (N-Methyl-D-Aspartate)-Receptor Antibodies and Long-Term Clinical Outcome After Stroke (PROSCIS-B)
| Autor: | Harald Prüss, Thomas G. Liman, Bob Siegerink, Sophie K. Piper, Matthias Endres, Shufan Huo, Pia S. Sperber, Peter U. Heuschmann, Jessica L. Rohmann |
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| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Male
therapy [Stroke] medicine.medical_specialty Context (language use) Receptors N-Methyl-D-Aspartate Disease-Free Survival 03 medical and health sciences 0302 clinical medicine Modified Rankin Scale Risk Factors Internal medicine Epidemiology medicine Humans Myocardial infarction ddc:610 Prospective Studies mortality [Stroke] Prospective cohort study Stroke blood [Brain Ischemia] 030304 developmental biology Aged Advanced and Specialized Nursing 0303 health sciences mortality [Brain Ischemia] business.industry Hazard ratio Odds ratio Middle Aged medicine.disease Magnetic Resonance Imaging Survival Rate blood [Stroke] therapy [Brain Ischemia] blood [Autoantibodies] Female Neurology (clinical) Cardiology and Cardiovascular Medicine business 030217 neurology & neurosurgery Follow-Up Studies |
| Zdroj: | Stroke 50(11), 3213-3219 (2019). doi:10.1161/STROKEAHA.119.026100 |
| Popis: | Background and Purpose— NMDAR1-abs (anti-N-Methyl-D-Aspartate receptor GluN1 antibodies), predominantly known in the context of autoimmune encephalitis, have been observed in serum of healthy individuals. A previous study found smaller stroke magnetic resonance imaging lesion growth in seropositive patients, suggesting a neuroprotective effect of these antibodies. The impact of NMDAR1-abs seropositivity on long-term functional outcome and recurrent vascular events and death after first-ever stroke remains unclear. Methods— Data from the Prospective Cohort with Incident Stroke—Berlin were used. NMDAR1-abs (ie, IgM, IgA, and IgG) were measured in serum within 7 days after first stroke. Outcomes of interest included modified Rankin Scale at one year and the time-to-event of a combined end point (recurrent stroke, myocardial infarction, and all-cause mortality) within 3 years. We calculated odds ratios from adjusted partial proportional odds models and subsequently compared outcome of patients with low titers (1:10; 1:32; and 1:100), and high titers (1:320; 1:1000) to seronegative patients. Furthermore, we estimated hazard ratios for a secondary vascular event or death in NMDAR1-abs seropositive compared to seronegative patients in models adjusted for confounders. Results— The analyses included 583 patients with antibody measurements (39% female, median National Institutes of Health Stroke Scale:2, IQR:1-4), and NMDAR1-abs were observed in 76 (13%) patients. NMDAR1-abs seroprevalence was not associated with functional outcome (odds ratio=1.27; 95% CI, 0.77–2.09); sub-group analyses, however, showed worse outcome in patients with high titers (odds ratio=3.47; 95% CI, 1.54–7.80). Seropositive patients had an increased risk for a secondary vascular event or death (hazard ratios =1.83, 95% CI, 1.10–3.05). Conclusions— In our study, NMDAR1-abs seropositivity was not associated with functional outcome at one year after stroke, however, high titers (≥1:320) were associated with poor functional outcome. Furthermore, NMDAR1-abs seropositivity was associated with increased cardiovascular risk within 3 years after first stroke, independently from other risk factors. Clinical Trial Registration— URL: https://www.clinicaltrials.gov . Unique identifier: NCT01363856. |
| Databáze: | OpenAIRE |
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