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Predictive Value of Cystatin C for Stroke Recurrence in Patients With Acute Ischemic Stroke
Huihui Liu1,2, Sifan Qian2, Chongke Zhong2
1Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University.
Insights
Cystatin C (CysC) predicts stroke recurrence in acute ischemic stroke patients, especially those with high inflammation. Higher CysC levels increase the risk of recurrent stroke and vascular events, highlighting its value in risk stratification.
Area of Science:
- Biochemistry
- Neurology
- Clinical Medicine
Background:
- Acute ischemic stroke poses a significant risk of recurrence and subsequent vascular events.
- Biomarkers are crucial for identifying high-risk patients and guiding preventative strategies.
- Cystatin C (CysC) has emerged as a potential marker for cardiovascular risk, but its role in stroke recurrence requires further elucidation.
Purpose of the Study:
- To investigate the predictive value of serum cystatin C (CysC) for stroke recurrence and vascular events in patients with acute ischemic stroke.
- To assess whether high-sensitivity C-reactive protein (hsCRP) modifies the association between CysC and adverse vascular outcomes.
- To determine if CysC improves risk reclassification for stroke recurrence and vascular events.
Main Methods:
- A post hoc analysis of the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS) cohort.
- Included 3,474 patients with acute ischemic stroke and documented serum CysC and hsCRP levels.
- Evaluated stroke recurrence and combined vascular events within 2 years post-stroke.
Main Results:
- Higher CysC concentrations (≥0.78 mg/L) were associated with increased risk of recurrent stroke (OR 2.48, P=0.003) and vascular events (OR 2.04, P=0.003) in patients with high hsCRP (≥4.8ng/mL).
- Serum hsCRP significantly modified the association of CysC with both recurrent stroke (Pinteraction=0.001) and vascular events (Pinteraction=0.007).
- CysC demonstrated significant improvements in risk reclassification for stroke recurrence (NRI 42.9%, P=0.001; IDI 1.2%, P=0.001) and vascular events (NRI 35.8%, P=0.001; IDI 1.1%, P=0.004).
Conclusions:
- In ischemic stroke patients with high hsCRP, elevated CysC levels significantly increase the risk of stroke recurrence and vascular events.
- The predictive value of CysC for stroke recurrence is dependent on the patient's inflammatory status.
- Cystatin C serves as a valuable biomarker for risk stratification in acute ischemic stroke patients, particularly in the context of inflammation.
Background:
This study explored the value of cystatin C (CysC) in predicting stroke recurrence in patients with acute ischemic stroke.
Methods And Results:
This was a post hoc analysis of the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS) on 3,474 acute ischemic stroke patients with documented serum CysC and high-sensitivity C-reactive protein (hsCRP) concentrations. Study outcomes included stroke recurrence and combined vascular events within 2 years after stroke. In stroke patients with higher (i.e., ≥4.8ng/mL), but not lower, hsCRP concentrations, a higher CysC concentration (i.e., ≥0.78 mg/L) was associated with a 2.48-fold increase in the risk of recurrent stroke (95% confidence interval [CI] 1.37-4.51; P=0.003) and a 2.04-fold increase in the risk of vascular events (95% CI 1.27-3.28; P=0.003). Serum hsCRP concentrations significantly modified the association of serum CysC with recurrent stroke (Pinteraction=0.001) and vascular events (Pinteraction=0.007). Moreover, CysC may improve reclassification of stroke recurrence (net reclassification improvement [NRI] 42.9%, P=0.001; integrated discrimination improvement [IDI] 1.2%, P=0.001) and vascular events (NRI 35.8%, P=0.001; IDI 1.1%, P=0.004).
Conclusions:
In ischemic stroke patients with high hsCRP concentrations, higher CysC concentrations increased the risk of stroke recurrence and vascular events. This indicates that the predictive value of CysC on stroke recurrence may depend on the inflammation status of patients.
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