Increased Serum EphrinA1 Is Associated With Parenchymal Hematoma (PH) After Ischemic Stroke.

Introduction Previous preclinical studies reported that the level of serum EphrinA1 was associated with blood-brain barrier (BBB) disruption, while its role in predicting parenchymal hematoma (PH) after ischemic stroke has not been investigated. We aimed to explore the association between the level of serum EphrinA1 and PH in patients with ischemic stroke. Methods Patients with ischemic stroke within 24 hours after onset from West China hospital, Sichuan University, were prospectively enrolled between January 2017 and December 2019.The level of serum EphrinA1 at baseline was measured within 24 hours after admission. PH was diagnosed as hematoma within the infarct territory detected on the brain CT/MRI scans within 7 days after onset, but not on the initial scan according to European Cooperative Acute Stroke Study (ECASS) III criteria. The association between the level of serum EphrinA1 and PH after ischemic stroke was assessed by multiple logistic regression analysis. Results A total of 667 patients were included in final analysis. The mean age was 67.20 ± 14.31 years and 57.87% (368/667) were men. Of the 667 patients, 65(9.75%) patients had PH. The median of EphrinA1 on admission was 82.83 ng/mL (IQR, 70.11-93.75 pg/mL). Compared with patients without PH, those with PH had higher level of serum EphrinA1 (P=0.024). Then patients were divided into 3 categories based on EphrinA1 tertiles (T1, <79.11 pg/mL, n=223; T2, 79.11-93.75 pg/mL, n=222; and T3, >93.75 pg/mL, n=22). After adjusting for age, sex, atrial fibrillation, smoking, statins, anti-platelets, Trail of Org 10172 in Acute Stroke Treatment (TOAST) classification and National Institutes of Health Stroke Scale (NIHSS) score≥15, patients in the second and third EphrinA1 tertiles showed a significant increase in PH compared with those in the lowest tertile (OR2.44, 95% CI1.10-5.40, P=0.028; OR 2.61, 95% CI 1.19-5.74, P=0.017, respectively). Additional adjusting for reperfusion therapy（thrombolysis and/or endovascular therapy）, only patients in the highest group(tertile 3) had a significantly higher risk of PH compared to the lowest group (OR 2.30, 95% CI1.03-5.13, P=0.042). Conclusion Higher serum EphrinA1 is independently associated with higher risk of PH after ischemic stroke. Future studies with larger sample size are needed to validate our findings and elucidate the potential role of EphrinA1 in PH.