Neopterin as a Predictor of Functional Outcome and Mortality in Chinese Patients with Acute Ischemic Stroke

Immune responses and inflammation play an important role in the pathogenesis of ischemic stroke. We therefore evaluated the 6-month prognostic value of early measurement of serum neopterin levels, a marker of inflammation and immune system activation, in Chinese patients with acute ischemic stroke (AIS). Consecutive AIS patients admitted to the emergency department were identified. Clinical information was collected. Serum concentration of neopterin and NIH stroke scale (NIHSS) were measured at the time of admission. Functional outcome was measured by modified Rankin scale (mRS) 6 months after admission. Multivariate analyses were performed using logistic regression models. During the inclusion period, 312 patients with first-ever AIS were included and 290 completed follow-up. The results indicated that the serum neopterin levels were significantly (P < 0.0001) higher in acutely ischemic stroke patients as compared to normal controls. Neopterin was an independent prognostic marker of 6-month functional outcome and death [odds ratio (OR) 4.33 (1.83–10.32) and 6.68 (2.44–12.13), respectively, P < 0.0001 for both, adjusted for NIHSS, other predictors and vascular risk factors] in patients with AIS. Neopterin improved the area under the receiver operating characteristic curve of the NHISS score for functional outcome from 0.75 (95 % CI 0.69–0.83) to 0.85 (95 % CI 0.79–0.91; P < 0.001) and for mortality from 0.76 (95 % CI 0.68–0.85) to 0.87 (95 % CI 0.81–0.94; P < 0.001). Serum neopterin is a useful, independent tool to predict functional outcome and mortality 6 months after stroke.