Abstract WP348: Soluble C-type Lectin-Like Receptor 2 as a Biomarker in Patients with Acute Ischemic Stroke or TIA: A Multicenter, Prospective Cohort Study

Background: We measured soluble C-type lectin-like receptor 2 (sCLEC-2), which is a new biomarker of platelet activation, to investigate clinical implications in patients with acute ischemic stroke (AIS) and TIA (Trial registration numbers: NCT05579405, UMIN 000048954). Methods: Plasma levels of sCLEC-2 were measured by high-sensitivity chemiluminescent enzyme immunoassay in 377 patients with AIS and 62 patients with TIA. Results: sCLEC-2/D-dimer ratio (mean±SD) at baseline (Day 1) was higher in patients with non-cardioembolic stroke/TIA (n=111, 491.9±433.7) than in those with cardioembolic stroke/TIA (n=52, 220.6±287.9) (t-test, p<0.0001) (patients on antithrombotics at baseline were excluded). Baseline sCLEC-2 levels (mean±SD) were 248.8±161.6, 277.6±210.6 (n=50), and 324.0±266.3 pg/ml in mild (NIHSS<6) (n=283), moderate (NIHSS 6-14) (n=50), and severe (NIHSS>14) (n=42) patients with AIS, respectively, which were higher in patients with severe AIS than in those with mild AIS (Tukey test, p=0.031). sCLEC-2 (mean±SD) at baseline was higher in patients with medium/large infarcts (n=97, 282.4±192.8 pg/ml) than in those with small infarcts (n=117, 233.6±115.1 pg/ml) among patients with non-cardioembolic plus non-lacunar stroke (t-test, p=0.012), while it was lower in medium/large infarcts (n=63, 231.9±184.0 pg/ml) than in those with small infarcts (n=26, 341.9±347.0 pg/ml) among patients with cardioembolic stroke (t-test, p=0.003). Mean sCLEC-2 was increased in patients with worsening (recurrence or deterioration) (n=17, +84.4 pg/ml) and decreased in those without worsening (n=271, -10.3 pg/ml) between Day 1 and Day 7 (Welch-corrected t test, p=0.013). Poor outcome (mRS>1) at discharge was more common in patients with increased sCLEC-2 than in those with decreased sCLEC-2 between Day 1 and Day 7 (61.4% vs 39.1%, Fisher’s exact test, p=0.002). Poor outcome at 3 months was more common in patients with high sCLEC-2 levels (156 pg/ml or more) than in those with normal sCLEC-2 levels (<156 pg/ml) at Day 7 (36.1% vs 13.0%, Fisher’s exact test, p=0.024). Conclusions: sCLEC-2 was a promising biomarker for subtyping of AIS/TIA, accessing stroke severity, elucidating pathophysiology, and predicting outcomes in patients with AIS or TIA.