The association of plasma osteoprotegerin levels and functional outcomes post endovascular thrombectomy in acute ischemic stroke patients: a retrospective observational study

Abstract

Background Osteoprotegerin (OPG), also known as osteoclastogenesis inhibitory factor, is a tumor necrosis factor receptor superfamily component. There is an established relationship between OPG and cardiovascular disease. We hypothesized that plasma OPG levels are associated with functional outcomes in acute ischemic stroke patients who have undergone endovascular thrombectomy (EVT). Methods From April 2014 through December 2020, a total of 360 acute ischemic stroke patients who underwent EVT were prospectively included in this retrospective observational study. Plasma OPG was measured after fasting for 12 postoperative hours after EVT. A modified Rankin Scale (mRS) was used to assess functional outcomes 3 months after index stroke occurrence. Univariate and multivariate binary logistic regression and ordinal logistic regression analyses were performed to investigate the association of plasma OPG levels with poor functional outcomes. Results Overall, 145 (40.2%) patients had poor (mRS > 2) outcomes. The mean ± standard deviation plasma OPG level was 200.2 ± 74.4 pg/mL. Multivariate analysis after adjusting for sex, body mass index, and variables with p < 0.1 in the preceding univariate analysis revealed high plasma OPG levels were independently associated with poor functional outcomes (highest tertile vs. lowest tertile of OPG; odds ratios (OR) 2.121, 95% confidence interval (CI) [1.089–4.191], p = 0.037 in binary logistic regression, OR 2.102, 95% CI [1.301–3.412], p = 0.002 in ordinal logistic regression analysis). Conclusions This study demonstrated that higher plasma OPG levels were associated with poor functional outcomes in acute ischemic stroke patients who underwent EVT.

Prognostic effect of osteoprotegerin in patients with ischemic stroke: A systematic review and meta-analysis

“…mortality [9], while two studies reported only poor functional outcome [13,14], and two other studies reported only mortality [15,16].…”

“…Following removing duplicates and screening the titles and abstracts, 28 articles were deemed potentially suitable for inclusion. After conducting a comprehensive full-text review, five studies [9,[13][14][15][16] were ultimately included in the meta-analysis. The quality assessment of the included studies was performed using NOS (see Table 1; detailed scores provided in S4 Table ).…”

“…The quality assessment of the included studies was performed using NOS (see Table 1; detailed scores provided in S4 Table ). One study received a score of 8 stars [13], while the remaining four studies received scores of 7 stars [9,[14][15][16], indicating a high level of quality for each study.…”

“…These studies were published between 2009 and 2023, with sample sizes ranging from 240 to 3,490, totaling 4,506 patients. The majority of enrolled patients exhibited symptoms of acute ischemic stroke within 7 days, including those who underwent endovascular thrombectomy in the investigation conducted by Park et al [14]. One study provided aOR and 95% confidence intervals for both poor functional outcome and…”

“…While certain studies have demonstrated an association between OPG and the occurrence of IS [3,10,11], others have not [7,12]. Moreover, a significant association has been observed between elevated OPG levels and poor functional outcome [9,13,14] as well as increased mortality [9,15,16]. However there is also evidence indicating that serum levels of OPG and RANKL do not exhibit a significant correlation with radiological or clinical parameters and scores in patients with ischemic stroke [17].…”