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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Serum Hepatocyte Growth Factor Is Probably Associated With 3-Month Prognosis of Acute Ischemic Stroke
Zhengbao Zhu1, Tan Xu1, Daoxia Guo1
1From the Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China (Z.Z., T.X., D.G., X.H., C.Z., J.Y., A.W., T.X., H.P., Y.Z.); Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA (C.Z., C.-S.C., J.C., J.H.); Department of Epidemiology, School of Public Health, Guizhou Medical University, Guiyang, China (J.Y.); Department of Neurology, Affiliated Hospital of North China University of Science and Technology, Hebei, China (Y.P.); Department of Neurology, Affiliated Hospital of Nantong University, Jiangsu, China (T.X.); Department of Neurology, Yutian County Hospital, Hebei, China (J.W.); Department of Cardiology, the First Affiliated Hospital of China Medical University, Liaoning (Y.S.); Department of Epidemiology, School of Public Health, Taishan Medical College, Shandong, China (Q.L.); Department of Neurology, Kerqin District First People's Hospital of Tongliao City, Inner Mongolia, China (Z.J.); Department of Neurology, Affiliated Hospital of Xuzhou Medical College, Jiangsu, China (D.G.); and Department of Medicine, Tulane University School of Medicine, New Orleans, LA (J.C., J.H.).
Insights
Elevated serum hepatocyte growth factor (HGF) is linked to a higher risk of poor outcomes in ischemic stroke patients. This association is particularly strong in those not pre-treated with heparin.
Area of Science:
- Biochemistry
- Cardiovascular Research
- Neurology
Background:
- Serum hepatocyte growth factor (HGF) is a known indicator of poor prognosis in heart failure and myocardial infarction.
- HGF has also shown potential in predicting the risk of ischemic stroke in general populations.
Purpose of the Study:
- To investigate the association between serum HGF levels and the prognosis of acute ischemic stroke.
- To determine if HGF can serve as an independent predictor of poor outcomes in stroke patients.
Main Methods:
- A post hoc analysis of 3027 patients from the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS).
- Primary outcome defined as a composite of death or major disability (modified Rankin Scale score ≥3) within 3 months post-stroke.
- Multivariate regression analysis and risk reclassification models were used to assess HGF's predictive value.
Main Results:
- Elevated serum HGF levels were significantly associated with an increased risk of the primary outcome (death or major disability).
- Each standard deviation increase in log-transformed HGF correlated with a 14% increased risk of poor prognosis.
- Adding HGF to conventional risk factors improved the prediction of stroke outcomes, demonstrating significant net reclassification improvement.
Conclusions:
- Higher serum HGF levels are associated with poor prognosis in ischemic stroke patients, potentially independent of stroke severity.
- The predictive value of HGF for poor stroke prognosis was notably stronger in patients without heparin pre-treatment.
- Further validation in diverse ischemic stroke populations is recommended to confirm these findings.
Background And Purpose:
Serum hepatocyte growth factor (HGF) is positively associated with poor prognosis of heart failure and myocardial infarction, and it can also predict the risk of ischemic stroke in population. The goal of this study was to investigate the association between serum HGF and prognosis of ischemic stroke.
Methods:
A total of 3027 acute ischemic stroke patients were included in this post hoc analysis of the CATIS (China Antihypertensive Trial in Acute Ischemic Stroke). The primary outcome was composite outcome of death or major disability (modified Rankin Scale score ≥3) within 3 months.
Results:
After multivariate adjustment, elevated HGF levels were associated with an increased risk of primary outcome (odds ratio, 1.50; 95% confidence interval, 1.10-2.03; Ptrend=0.015) when 2 extreme quartiles were compared. Each SD increase of log-transformed HGF was associated with 14% (95% confidence interval, 2%-27%) increased risk of primary outcome. Adding HGF quartiles to a model containing conventional risk factors improved the predictive power for primary outcome (net reclassification improvement: 17.50%, P<0.001; integrated discrimination index: 0.23%, P=0.022). The association between serum HGF and primary outcome could be modified by heparin pre-treatment (Pinteraction=0.001), and a positive linear dose-response relationship between HGF and primary outcome was observed in patients without heparin pre-treatment (Plinearity<0.001) but not in those with heparin pre-treatment.
Conclusions:
Serum HGF levels were higher in the more severe stroke at baseline, and elevated HGF levels were probably associated with 3-month poor prognosis independently of stroke severity among ischemic stroke patients, especially in those without heparin pre-treatment. Further studies from other samples of ischemic stroke patients are needed to validate our findings.
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