Research Paper Volume 15, Issue 4 pp 1199—1209

Prognostic performance of serum YKL-40 for one-year clinical outcomes in acute ischemic stroke

Guomei Shi1,2, *, , Minghao Li3, *, , Yan E4, , Meng Wang4, , Pengyu Gong4, , Xiaorong Wang1, , Jingye Lu1,2, , Weixiang Wu1, , Shouru Xue2, , Junshan Zhou4, &, , Rujuan Zhou1, &, ,

  • 1 Department of Neurology, The Taixing People’s Hospital, Taixing 225400, Jiangsu Province, China
  • 2 Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
  • 3 Department of Vascular Surgery, The Taixing People’s Hospital, Taixing 225400, Jiangsu Province, China
  • 4 Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210001, Jiangsu Province, China
* Equal contribution

Received: October 26, 2022       Accepted: February 20, 2023       Published: February 25, 2023
How to Cite

Copyright: © 2023 Shi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Background: Effects of YKL-40 on one-year clinical outcomes including poor clinical outcome, all-cause mortality, and stroke recurrence among acute ischemic stroke (AIS) patients remained elusive. The purpose of this study was to explore the association between serum YKL-40 at admission and one-year clinical outcomes in AIS patients.

Methods: In this prospective cohort study, a total of 1002 participants out of 1361 AIS patients from two centers were included for current analysis. Serum YKL-40 concentrations were measured via enzyme-linked immunosorbent assay. Multivariable logistic or Cox regression were performed to explore the independent association of YKL-40 with one-year clinical outcomes, including poor outcome (modified Rankin Scale of 3-6), all-cause mortality, and recurrent stroke. C-statistic, net reclassification index (NRI) and integrated discrimination improvement (IDI) were calculated to evaluate the discriminatory and predictive power of YKL-40 when added to conventional model.

Results: Compared with the first quartile of YKL-40, the adjusted odds ratios or hazard ratios with 95% confidence intervals of the fourth quartile were 3.032 (1.627-5.650) for poor outcome, 2.886 (1.320-6.308) for all-cause mortality and 1.694 (0.906-3.169) for recurrent stroke. The addition of serum YKL-40 to conventional model significantly improved reclassification for poor outcome (NRI 0.053, P = 0.031; IDI 0.018, P = 0.001) and all-cause mortality (NRI 0.162, P = 0.036).

Conclusions: Elevated serum YKL-40 at admission might be independently associated with one-year poor outcome and all-cause mortality but not stroke recurrence among Chinese AIS patients.


AIS: acute ischemic stroke; BRP-39: breast regression protein 39; CHI3L1: chitinase-3-like-1 protein; mRS: modified Rankin Scale; NIHSS: National Institutes of Health Stroke Score; SAP: stroke associated pneumonia; TC: total cholesterol; TG: triglyceride; LDL: low-density lipoprotein; HDL: high-density lipoprotein; FBG: fasting blood glucose; hs-CRP: high sensitivity C-reactive protein; TOAST: Trial of Org 10172 in Acute Stroke Treatment; LAA: large-artery atherosclerosis; CE: cardioembolism; SAO: small-artery occlusion; SOE: stroke of other determined etiology; SUE: stroke of undetermined etiology; SD: standard deviation; IQRs: interquartile ranges; ORs: Odds ratios; HRs: hazard ratios; CIs: confidence intervals; NRI: net reclassification index; IDI: integrated discrimination improvement; TNF: tumor necrosis factor; IL: interleukin.