Plasma Chromogranin A Levels Are Associated With Acute Ischemic Stroke With Anterior Circulation Large Vessel Occlusion

Background: Large vessel occlusion(LVO)stroke accounts for approximately onequarter of acute ischemic stroke(AIS),anterior circulation LVO leads to more severe neurological deficits and worse prognosis than posterior circulation LVO.Chromogranin A(CgA)can regulate inflammation,metabolism,angiogenesis in many tissues.To our knowledge,there are few studies on plasma CgA levels and strokes.Therefore,we sought to investigate the association between plasma CgA levels and the risk of AIS,especially anterior circulation LVO strokes.Methods: 587 subjects were included in this study,including 205 AIS patients with anterior circulation LVO and 205 nonocclusive patients,as well as 177 healthy controls.Medical records and routine blood tests of all subjects were collected.Plasma CgA levels were measured by ELISA kit.Neurological deficits were assessed by the NIH Stroke Scale(NIHSS),and outcomes in 3 months were assessed by the modified Rankin Scale(m RS).SPSS 23 software was used for statistical analysis.First,receiver operating characteristic(ROC)curve analysis was used to determine the diagnostic accuracy of continuous CgA in predictingAIS.Second,binary logistic analysis was used to assess the association of the pre-established cutoff value of CgA and AIS,as well as anterior circulation LVO.Bilateral P<0.05 indicated a statistically significant difference.Results: AIS patients had lower CgA levels than health controls(P<0.001).ROC curve analysis was used to distinguish patients with AIS from healthy controls,and the area under the curve(AUC)was 0.752(95% CI: 0.710–0.794,P<0.001),the optimal cutoff value was 17.87 ng/m L,and the sensitivity and specificity were 65.6% and 77.4%respectively.After adjustment for conventional vascular risk factors including age,sex,body mass index(BMI),hypertension,systolic blood pressure,diastolic blood pressure,diabetes,smoking,drinking and significant variables from the univariate variables including triglyceride(TG),total cholesterol(TC),low-density lipoprotein(LDL),highdensity lipoprotein(HDL),creatinine(Cr),uric acid(UA)and WBCs,CgA ≤17.87 ng/m L was still an independent risk factor for AIS(OR=7.669,95% CI: 4.663–12.612,P<0.001).The CgA levels of patients with anterior circulation LVO were significantly lower than those of patients with nonocclusive AIS(P<0.001).ROC analysis was used to distinguish anterior circulation LVO from nonocclusive patients,and the AUC was 0.744(95% CI:0.698–0.791,P<0.001).The cutoff value was 15.49 ng/m L.The sensitivity and specificity were 52.2% and 81.0%.CgA≤15.49 ng/m L remained an independent risk factor for anterior circulation LVO after adjusting for vascular risk factors and TG,Cr,UA and CRP(OR=6.519,95% CI: 3.790–11.214,P<0.001)Multiple logistic analysis found that CgA levels remained a protective factor for mild stroke and good prognosis after adjusting for conventional vascular risk factors(P=0.007,P=0.005);however,the association disappeared after adjusting for vessel occlusion(P=0.689,P=0.335).Conclusion: CgA levels were lower in AIS patients,especially in anterior circulation LVO patients.Lower CgA levels are potential biomarker for anterior circulation LVO,and they may indicate good prognosis at 3 months in AIS.