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Circulating granulocyte colony-stimulating factor and functional outcome after ischemic stroke: an observational
Alexander Wall1,2, Olof Anger1, Katarina Jood3
1Department of Internal Medicine, Institute of Medicine, the Sahlgrenska Academy at the University of Gothenburg, Sweden.
Neurological Research
|July 13, 2021
Summary
Early high levels of serum granulocyte colony-stimulating factor (G-CSF) in ischemic stroke patients correlate with worse outcomes. This finding suggests G-CSF may indicate inflammation severity rather than a direct therapeutic target for stroke recovery.
Area of Science:
- Neurology
- Immunology
- Biochemistry
Background:
- Granulocyte colony-stimulating factor (G-CSF) shows promise in experimental ischemic stroke (IS) models, but clinical translation remains elusive.
- Previous observational studies reported inconsistent associations between G-CSF, stroke severity, and functional outcomes.
- A larger study is needed to clarify the role of endogenous G-CSF in IS patients.
Purpose of the Study:
- To investigate the association between endogenous serum G-CSF (S-GCSF) levels and stroke severity and functional outcomes in a large cohort of IS patients.
- To determine if acute S-GCSF levels predict short-term and long-term functional outcomes after ischemic stroke.
Main Methods:
- Serum G-CSF was measured in 435 IS patients during the acute phase and at 3 months post-stroke.
- Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS).
- Functional outcomes were evaluated using the modified Rankin Scale (mRS) at 3 months and 2 years.
- Correlation and logistic regression analyses, with confounder adjustments, were employed.
Main Results:
- Acute S-GCSF levels were significantly higher (23%) than at 3 months post-stroke (p < 0.001).
- Acute S-GCSF showed a weak correlation with stroke severity (r = 0.12, p = 0.013) and hs-CRP (r = 0.29, p < 0.001).
- Elevated acute S-GCSF (quintile 5 vs. 1) was associated with poor 3-month functional outcome (mRS 3-6) (aOR = 4.27, p = 0.001), even after adjusting for risk factors and stroke subtype, but not stroke severity.
- Neither post-stroke changes in S-GCSF nor absolute 3-month S-GCSF levels correlated with functional outcomes at 3 months or 2 years.
Conclusions:
- Early post-stroke S-GCSF is elevated in patients with severe ischemic stroke.
- Higher acute S-GCSF levels are associated with poorer functional outcomes at 3 months, likely reflecting inflammation in large infarctions.
- The change in S-GCSF and 3-month S-GCSF levels appear less significant for predicting long-term outcomes.
