Influence of lipoprotein-associated phospholipase A2 mass on prognosis value of baseline platelet count for clinical outcomes after acute ischemic stroke

Abstract

Background and aimsWe aimed to examine the association between baseline platelet count (PLT) and prognosis of acute ischemic stroke according to lipoprotein-associated phospholipase A2 (Lp-PLA2) mass. MethodsA total of 3254 patients with acute ischemic stroke were included in this analysis. The primary outcome was a combination of major disability and all-cause mortality (modified Rankin Scale score ≥3) at 3 months after stroke. Secondary outcome was major disability and all-cause mortality, respectively. ResultsThe prognosis value of PLT for primary outcome was significantly modified by Lp-PLA2 mass (pinteraction = 0.002). After multivariate adjustment, elevated PLT was associated with the increased risk of primary outcome in patients with high Lp-PLA2 mass (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.09–2.48; ptrend = 0.002), but not in those with low Lp-PLA2 mass (OR, 0.94; 95%CI, 0.62–1.42; ptrend = 0.181), when comparing two extreme PLT quartiles. A similar association was found between elevated PLT and major disability (pinteraction = 0.001). Elevated PLT was associated with increased risk of major disability only in patients with high Lp-PLA2 mass (OR, 1.54; 95%CI, 1.03–2.31; ptrend = 0.007), for the highest quartile vs the lowest quartile. Each 100 × 109/L increment in PLT was associated with 42% (95%CI, 12%–79%) increased risk of primary outcome and 33% (95%CI, 6%–68%) increased risk of major disability in those with high Lp-PLA2 mass. ConclusionsThe elevated PLT was associated with poor prognosis of acute ischemic stroke only in patients with high Lp-PLA2 mass. Lp-PLA2 might be an important factor influencing the prognosis value of PLT for clinical outcomes in acute ischemic stroke patients.