Plasma Heparin-Binding Protein as a Predictor of Functional Recovery and a Potential Therapeutic Target in Acute Anterior Circulation Large-Vessel Occlusion Stroke

TL;DR

High levels of a protein called HBP in stroke patients after a procedure to remove blood clots are linked to worse recovery, suggesting it could help predict outcomes and guide treatment.

Contribution

This study identifies plasma HBP as an independent predictor of poor recovery in stroke patients after mechanical thrombectomy and suggests its potential as a therapeutic target.

Findings

Higher HBP levels were significantly associated with poor functional outcomes in stroke patients.

HBP remained an independent predictor of poor outcomes after adjusting for multiple clinical factors.

Adding HBP to clinical models improved the accuracy of predicting patient outcomes.

Abstract

Background: Patients with acute anterior circulation large-vessel occlusion (AC-LVO) stroke frequently experience poor outcomes despite successful mechanical thrombectomy (MT). Heparin-binding protein (HBP), a neutrophil-derived mediator of inflammation and vascular permeability, may contribute to neuroinflammation and prognosis; however, its role in stroke remains unclear. Methods: In this retrospective study, 163 patients with AC-LVO stroke who underwent MT were enrolled. Plasma HBP levels were measured within 24 h after thrombectomy. Functional outcomes were evaluated using the modified Rankin Scale (mRS) at 90 days, with an mRS score 3–6 suggesting a poor outcome. Multivariable logistic regression and receiver operating characteristic (ROC) analyses were performed to assess associations between HBP and outcomes. Results: Of the 163 patients, 88 (54.0%) had poor functional outcomes. The median plasma HBP level of patients with poor outcomes was significantly higher than that of patients with good outcomes (28.80 vs. 18.42 ng/mL; p < 0.001). HBP remained independently associated with poor outcome (odds ratio [OR] 1.04; 95% confidence interval [CI] 1.01–1.07; p = 0.002) after adjusting for demographic, clinical, procedural, and laboratory covariates. ROC analysis showed a modest predictive value of HBP alone (area under the curve [AUC] = 0.671), whereas adding HBP to clinical models improved prognostic accuracy (AUC = 0.835 for model 2; AUC = 0.889 for model 3). Conclusions: For patients with AC-LVO stroke, elevated plasma HBP within 24 h after MT serves as an independent predictor of unfavorable functional outcomes at 90 days. Thus, HBP may serve as a prognostic biomarker and potential target for immunomodulatory therapy.

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