Associations of Plasma Deoxycholic Acid and Its Conjugates With the Clinical Outcomes After Ischemic Stroke

Deoxycholic acid (DCA) and its conjugates glycodeoxycholic acid (GDCA), taurodeoxycholic acid, and 23-nordeoxycholic acid (NorDCA) were implicated in anti-inflammation and energy metabolism, but their prognostic values in ischemic stroke remained unclear. We aimed to investigate the associations of plasma DCA and its conjugates with outcomes after ischemic stroke in a multicenter prognostic cohort study.

Our multicenter prognostic cohort study included 3405 Chinese patients with hypertensive stroke from the China Antihypertensive Trial in Acute Ischemic Stroke. The primary outcome was a composite outcome of death and major disability (modified Rankin Scale score, 3-6) at 3 months after ischemic stroke.

After adjustment for age, sex, and other important covariates, elevated plasma DCA (odds ratio [OR], 0.65 [95% CI, 0.53-0.80]), GDCA (OR, 0.76 [95% CI, 0.61-0.93]), and NorDCA (OR, 0.73 [95% CI, 0.59-0.89]) were associated with a decreased risk of primary outcome when 2 extreme tertiles were compared. Multiple-adjusted spline regression model showed linear associations of DCA, GDCA, and NorDCA with the primary outcome (all P value for linearity<0.05). Adding DCA, GDCA, NorDCA, or DCA metabolite score to conventional prognostic factors significantly improved the risk reclassification for the primary outcome, as evidenced by net reclassification improvement and integrated discrimination index (all P<0.05).

High DCA, GDCA, and NorDCA at baseline were associated with decreased risks of adverse outcomes at 3 months after ischemic stroke, indicating that DCA, GDCA, and NorDCA might be implicated in the development of ischemic stroke and could be valuable intervention targets for ischemic stroke.