Time-dependent,dynamic prediction of fatty acid-binding protein 4,Galectin-3,and soluble ST2 measurement with poor outcome after acute stroke

Abstract

Background

Time-dependent change in the level of biomarkers after stroke is not well understood. We sought to compare fatty acid-binding protein 4 (FABP4), Galectin-3, and soluble ST2 to ascertain for a change in prediction of outcome at admission and 48 h later.

Methods

Plasma FABP4, Galectin-3, and soluble ST2 were measured in biospecimens from acute stroke patients at the time of admission (n = 383) and 48 h later (n = 244). Functional outcome was assessed at 90 days using the modified Rankin Scale and dichotomized into good (modified Rankin Scale 0–2) and poor outcome (modified Rankin Scale 3–6).

Results

On admission, elevated levels of each biomarker predicted poor outcome (FABP4: OR 1.92, 95% CI 1.42–2.59, P < 0.0001; Galectin-3: OR 1.85, 95% CI 1.42–2.40, P < 0.0001; soluble ST2: OR 1.55, 95% CI 1.22–1.97, P < 0.0001) and death (FABP4: OR 2.45; 95% CI 1.51–3.98; P < 0.0001; Galectin-3: OR 2.12; 95% CI 1.50–3.30; P < 0.0001; soluble ST2: OR 2.17; 95% CI 1.58–2.99; P < 0.0001). At 48 h, soluble ST2 predicted poor outcome (OR 2.62, 95% CI 1.77–3.88, P < 0.0001) and mortality (OR 3.36, 95% CI 2.06–5.48, P < 0.0001), and Galectin-3 predicted mortality only (OR 1.81, 95% CI 1.05–3.10, P = 0.033). FABP4 measured at 48 h was not predictive of outcome or death. Associations of Galectin-3 and soluble ST2 with outcome or mortality were independent of age, sex, and NIHSS, whereas those with FABP4 were not.

Conclusions

Galectin-3 performed better when measured on admission, whereas soluble ST2 was predictive at admission and better at 48 h after stroke. The time-dependent differences may reflect the evolving role of these pathways after acute stroke.