The value of serum ZAG levels in predicting the progression and prognosis of acute ischemic stroke

Abstract

Objective: The aim of this study was to investigate the value of serum zinc-alpha2-glycoprotein (ZAG) levels in predicting the progression and prognosis of acute ischemic stroke (AIS).

Methods: A total of 210 patients with AIS who were hospitalized for 72 hours were included in the case group, and 52 patients undergoing health check-ups at the hospital in the same period were included in the control group. Serum ZAG levels were measured early in the morning on the second day after admission via enzyme-linked immunosorbent assay (ELISA). For patients with AIS, those whose National Institutes of Health Stroke Scale (NIHSS) score progression was greater than 2 were regarded as the progression group, while those whose NIHSS score was less than 2 were regarded as the nonprogression group. Prognosis was assessed via the modified Rankin scale (mRS) score after 90 days: an mRS score > 2 was considered a poor prognosis. Logistic regression was used to analyze whether the serum ZAG level was an independent factor affecting the risk of disease progression and the long-term prognosis of AIS. Nomogram models were developed to predict the progression and prognosis of AIS.

Results: The serum ZAG level was significantly lower in AIS patients than in controls. The binary logistic regression analysis revealed that the serum ZAG level [odds ratio (OR) 0.963, 95% confidence interval (CI): 0.948–0.979, P < 0.01] may be an independent factor for the risk of AIS onset. Subsequent single-factor analysis revealed that the serum ZAG level in the AIS progression group was lower than that in the nonprogression group. Binary logistic regression analysis also revealed that the serum ZAG level was an independent factor (OR 0.968, 95% CI: 0.947–0.991, P = 0.005) for the risk of AIS progression. Consistently, the serum ZAG level in the poor AIS prognosis group was lower than that in the good prognosis group, and binary logistic regression analysis revealed that the serum ZAG level was an independent risk factor for poor prognosis of acute cerebral infarction (OR 0.937, 95% CI: 0.905–0.969; P < 0.01). Nomogram models including the serum ZAG level to predict the progression and prognosis of AIS showed good prediction ability.

Conclusion: There is a close association between serum ZAG levels and the onset of AIS. A lower serum ZAG level may predict AIS progression and long-term poor prognosis.