Serum YKL-40 Levels and White Matter Hyperintensities in Patients with Acute Ischemic Stroke

Guomei Shi,1,2,* Dongdong Ke,2,3,* Pengyu Gong,4,5 Peng Yu,2,6 Junshan Zhou,5 Meng Wang,5 Xiaohao Zhang,5 Xiaorong Wang,1,2 Minwang Guo,1,2 Mingyang Xu,1,2 Rujuan Zhou1,2 1Department of Neurology, the Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China; 2Stroke Center, the Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China; 3Department of Rehabilitation, the Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China; 4Department of Neurology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, People’s Republic of China; 5Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China; 6Department of Radiology, the Taixing People’s Hospital, Taixing, Jiangsu, People’s Republic of China*These authors contributed equally to this workCorrespondence: Rujuan Zhou, Tel +86-13951158499, Email zhourujuan123@163.comBackground: White matter hyperintensity (WMH) is associated with risk of acute ischemic stroke (AIS) and poor outcomes after AIS. The purpose of this prospective study was to evaluate the association between serum YKL-40 levels and WMH burden in patients with AIS.Methods: From February 2020 to March 2021, a total of 672 consecutive AIS patients with magnetic resonance imaging data were prospectively recruited form two centers. Serum YKL-40 levels were quantified using enzyme-linked immunosorbent assay. The burden of WMH was semiquantitatively measured by the Fazekas visual grading scale. According to severity of overall WMH, patients were dichotomized into none–mild WMH group (Fazekas score 0– 2) or moderate–severe WMH group (Fazekas score 3– 6). Besides, based on severity of periventricular WMH (PV-WMH) and deep WMH (D-WMH), patients were categorized as none–mild (Fazekas score 0– 1) or moderate–severe (Fazekas score 2– 3).Results: Among the 672 patients, 335 (49.9%) participants were identified with moderate–severe overall WMH, 326 (48.5%) with moderate–severe PV-WMH and 262 (39.0%) with moderate–severe D-WMH. Compared with the first quartile of serum YKL-40, the adjusted odds ratio (OR) of the fourth quartile for moderate–severe PV-WMH was 2.473 (95% confidence interval [CI] 1.316– 4.646; P=0.005). No significant association was observed between YKL-40 and overall WMH (OR 0.762; 95% CI 0.434– 1.336; P=0.343) or D-WMH (OR 0.695; 95% CI 0.413– 1.171; P=0.172).Conclusion: Our results suggested that higher YKL-40 levels appeared to be associated with PV-WMH, but not with overall WMH or D-WMH in patients with AIS.Keywords: acute ischemic stroke, YKL-40, white matter hyperintensities, biomarkers