Galectin-3 identified as marker of poor outcomes after acute ischemic stroke

Higher levels of serum galectin-3, a protein involved in adhesion and proliferation of cells and immune response, may independently predict worse outcomes in the 3 months after ischemic stroke, according to a study recently published in Stroke.

Based on an analysis of over 3,000 participants with acute ischemic stroke included in the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS), researchers led by Aili Wang, PhD, Medical College of Soochow University, Suzhou, China, found that those who had serum galectin-3 levels in the highest quartile at baseline were at twice the risk of dying compared with patients whose levels were in the lowest quartile.

Galectin-3 may improve risk prediction when added to conventional risk factors in patients with acute ischemic stroke, they suggested.

Elevated levels of galectin-3 levels had previously been found to predict poor outcomes in some clinical studies of patients with heart failure. The current analysis by Dr. Wang and colleagues is the first prospective cohort study to examine the association in patients with ischemic stroke.

CATIS was a multicenter, single-blind randomized clinical trial conducted in 26 centers across China. Some 4,071 patients 22 years and older with ischemic stroke were recruited. Of these, 3,082 had qualified blood samples and were enrolled. The participants were divided into quartiles according to baseline values of serum galectin-3. The primary outcome of this analysis was a composite of death and major disability, defined as a score of 3 to 6 on the modified Rankin scale, at 3 months after stroke onset.

On multivariate analysis, the odds ratio (OR) for the primary composite outcome was increased by 55% in patients in the highest quartile of galectin-3 relative to the lowest quartile. Also, in the highest quartile compared with the lowest, ORs for death were 2.10, for major disability 1.43, and for a 1-unit increase in the modified Rankin score 1.63.

Every standard deviation increase of galectin-3 level was positively associated with poor outcomes. When patients with a history of coronary heart disease were excluded, elevated serum galectin-3 remained significantly associated with the risk of a primary outcome event.

For the primary outcome, adding galectin-3 to a model incorporating established risk factors before stroke onset served to significantly improve predictive ability, and reclassified risk in 18.9%. For the outcome of death, adding galectin-3 reclassified 33.7% and for major disability, it reclassified 16.9%.

“Our findings supported the hypothesis that serum galectin-3 may have [a] potential role in inflammation, atherosclerosis pathogenesis, and plaque rupture, so high galectin-3 level could be involved in tissue injury and sequent poor outcome,” wrote Dr. Wang and colleagues.

“Routine galectin-3 measurement in patients with ischemic stroke may provide important novel clinical use. In addition, some studies should be encouraged in regarding to galectin-3 inhibitors and whether lowering serum galectin-3 could prevent the poor outcome of ischemic stroke,” they concluded.