Serum ADAMTS18 Levels at Admission Are Associated With 3-Month Functional Outcome After Acute Ischemic Stroke

ADAMTS18 is a secreted metalloproteinase implicated in vascular homeostasis and protection against ischemic brain injury. However, its clinical relevance in acute ischemic stroke (AIS) remains unclear.

We retrospectively analyzed 194 AIS patients from the Chengdu Stroke Registry. Serum ADAMTS18 levels were measured within 48 hours of admission using ELISA. Associations between ADAMTS18 levels and 3-month poor outcomes (modified Rankin Scale score 3-6) were evaluated using logistic regression. Predictive performance was assessed using area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI).

Among 194 patients, the median ADAMTS18 was 21.45 ng/mL (IQR 19.68-23.58 ng/mL), 79 (40.7%) had poor outcomes. Patients with poor outcomes had lower serum ADAMTS18 levels [19.84 (18.46-21.24) vs. 22.88 (21.14-24.81) ng/mL, P＜0.001]. After adjustment, lower ADAMTS18 levels were independently associated with poor outcome (OR 0.70, 95% CI 0.58-0.83, P＜0.001). Quartile analysis showed that compared with the lowest quartile, patients in Q3 (OR = 0.26; 95% CI: 0.08-0.83; P = 0.023) and Q4 (OR = 0.02; 95% CI: 0.00-0.11; P＜0.001) had progressively lower odds of poor functional outcome (P for trend ＜0.001). Restricted cubic spline analysis confirmed a negative linear association (adjusted P_overall＜0.001). Incorporating ADAMTS18 into predictive models improved discrimination (AUC = 0.91 vs. 0.86, P = 0.011), IDI (11.14%, P＜0.001), and NRI (77.1%, P＜0.001).

Lower admission ADAMTS18 levels are independently associated with poor 3-month functional outcomes after AIS and may provide additional prognostic information.