Serum ADAMTS18 Levels at Admission Are Associated With 3-Month Functional Outcome After Acute Ischemic Stroke

Abstract

Aims: ADAMTS18 is a secreted metalloproteinase implicated in vascular homeostasis and protection against ischemic brain injury. However, its clinical relevance in acute ischemic stroke (AIS) remains unclear.

Methods: We retrospectively analyzed 194 AIS patients from the Chengdu Stroke Registry. Serum ADAMTS18 levels were measured within 48 hours of admission using ELISA. Associations between ADAMTS18 levels and 3-month poor outcomes (modified Rankin Scale score 3-6) were evaluated using logistic regression. Predictive performance was assessed using area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI).

Results: Among 194 patients, the median ADAMTS18 was 21.45 ng/mL (IQR 19.68-23.58 ng/mL), 79 (40.7%) had poor outcomes. Patients with poor outcomes had lower serum ADAMTS18 levels [19.84 (18.46-21.24) vs. 22.88 (21.14-24.81) ng/mL, P＜0.001]. After adjustment, lower ADAMTS18 levels were independently associated with poor outcome (OR 0.70, 95% CI 0.58-0.83, P＜0.001). Quartile analysis showed that compared with the lowest quartile, patients in Q3 (OR = 0.26; 95% CI: 0.08-0.83; P = 0.023) and Q4 (OR = 0.02; 95% CI: 0.00-0.11; P＜0.001) had progressively lower odds of poor functional outcome (P for trend ＜0.001). Restricted cubic spline analysis confirmed a negative linear association (adjusted P_overall＜0.001). Incorporating ADAMTS18 into predictive models improved discrimination (AUC = 0.91 vs. 0.86, P = 0.011), IDI (11.14%, P＜0.001), and NRI (77.1%, P＜0.001).

Conclusion: Lower admission ADAMTS18 levels are independently associated with poor 3-month functional outcomes after AIS and may provide additional prognostic information.