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.
Highlights
Stroke and diabetes mellitus (DM) are two complicated diseases that often occur together(Malla et al 2019)
Stroke worsens glucose metabolism abnormalities, and the outcomes after stroke are more serious for diabetic patients compared with those without diabetes(Forti et al 2020; Lau et al 2019).The overlapping risk factors and genetic data from multiple human cohorts for diabetes mellitus and cerebrovascular disease support a concept that the two diseases share common antecedents and critical pathogenic mechanisms(Bao et al 2018; O'Donnell et al 2016; Shu et al 2017).Though inflammation is firmly established as central to the pathophysiology of both stroke and diabetes, the specific inflammatory processes involved may differ between them(Bao et al 2018).In diabetes mellitus, islet βcell dysfunction and obesity-driven insulin resistance induced by inflammation in adipose tissue are involved in the pathogenesis(Saltiel and Olefsky 2017)
Exclusion criteria were as follows: 1) patients were younger than 18 years old; 2) patients with cerebral infarction caused by subarachnoid hemorrhage, sinus venous thrombosis, or severe head trauma; 3) patients had a stroke history within 6 months or the modified Rankin scale > 0 before the onset; 4) patients had a history of infection within 2 weeks before admission that was defined as fever (T ≥ 38°C) and at least one other typical symptoms; 5) Patients had a history of hematological diseases, autoimmune diseases, or treatment with immunosuppressive agents; 6) patients with missing data
Summary
Stroke and diabetes mellitus (DM) are two complicated diseases that often occur together(Malla et al 2019). Other inflammation-related mechanisms like endothelial dysfunction, atherosclerosis and increased plaque vulnerability play important roles in cerebrovascular disease, especially for ischemic stroke(Roth et al 2018; Ruparelia et al 2017). The relationship between complement system and diabetes mellitus may be closer(Mellbin et al 2012).Plasma levels of C3 is an more effective and more highly specific predictor of diabetes than multiple other acute-phase proteins(Bao et al 2018; Borne et al 2017). Existing data are still limited and further investigation is required to explore the value of complement components for stroke patients, especially for those with diabetes
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