Antibodies to Cardiolipin in Stroke: Association with Mortality and Functional Recovery in Patients Without Systemic Lupus Erythematosus

Antibodies to cardiolipin were measured in 100 consecutive patientswith first ever stroke, on admission and at three and six monthsafter the acute event. One hundred healthy, age-and sex-matched,British elderly individuals were also screened for antibodiesto cardiolipin as a control group. Elevated levels of anticardiolipin antibody (i.e. 5SD abovethe laboratory control mean) were present in none of the controlgroup, but in 21 per cent of the patients with stroke. Thirteenof these 21 patients (62 per cent) died within three months,compared to 17 (21.5 per cent) of the seventy-nine patientswithout elevated levels of anticardiolipin antibodies (p<0.001).Six of the eight survivors with persistently elevated anticardiolipinantibodies had significant residual disability following stroke(Barthel score 0–9) compared to 11 of the 62 without (p<0.001).Two patients with initially raised anticardiolipin antibodieswho became independent at six months showed a progressive declinein the level of these antibodies to normal. The presence of high levels of anticardiolipin antibody didnot correlate with other recognized prognostic indices of stroke,except for incontinence. No correlation was noted between levelsof antibody to cardiolipin, antinuclear factor, antibody todouble-stranded DNA and C-reactive protein, either in the strokepatients or in the elderly control population. Hypertensionwas significantly more common in the patients with high anticardiolipinantibodies than in the rest of the patients in the stroke population(p=0.33). There was no correlation between levels of anticardiolipinantibody and age. Anticardiolipin antibody may be consideredas an independent prognostic marker for both mortality and clinicaloutcome after acute stroke.