Soluble thrombomodulin and brain infarction: case-control and prospective study.

Area of Science:

• Biochemistry
• Cardiovascular Medicine
• Neurology

Background:

• Soluble thrombomodulin (sTM) levels have shown conflicting associations with coronary events and brain infarction (BI).
• Previous research indicates sTM may predict fewer first-ever coronary events, but its role in BI risk and prognosis is less clear.
• The Etude du Profil Génétique de l'Infarctus Cérébral (GENIC) cohort provides a valuable dataset for investigating sTM in relation to BI.

Purpose of the Study:

• To investigate the relationship between sTM levels and the risk of first-ever BI.
• To examine the association between sTM levels and BI prognosis in patients with established BI.
• To determine if vascular history influences the interpretation of sTM levels in relation to BI.

Main Methods:

• A case-control study involving 492 BI patients and 492 matched hospital controls without stroke history.
• Blood samples were collected post-hospitalization, with sTM levels determined centrally.
• Analyses included all subjects and a subgroup with no prior vascular history.

Main Results:

• sTM concentration increased with age and hypertension but did not differ between BI cases and controls overall.
• In subjects without prior vascular history, elevated sTM (>59.6 microg/L) was associated with a reduced risk of first-ever BI (aOR 0.56).
• Among BI cases, higher sTM levels correlated with increased mortality risk during follow-up (aHR 1.19 per SD increase).

Conclusions:

• Elevated sTM may offer protection against initial BI in individuals without a history of vascular disease.
• In patients with a history of BI, increased sTM levels are associated with a poorer prognosis and higher mortality.
• The clinical interpretation of sTM levels in the context of BI requires careful consideration of the patient's vascular history.