Association of plasma ceramide with stroke-associated pneumonia in acute ischemic stroke.

Plasma ceramide levels (C16:0-Cer, C18:0-Cer, C24:1-Cer, C24:0-Cer) and CERT1 score were higher in patients with AIS than healthy controls.

• The study included 266 eligible patients with AIS and 93 healthy controls.
• All four ceramide subspecies measured — C16:0-Cer, C18:0-Cer, C24:1-Cer, and C24:0-Cer — were elevated in AIS patients compared to healthy controls.
• The Coronary Event Risk Test 1 (CERT1) score, a composite ceramide-based score, was also significantly higher in AIS patients than healthy controls.
• Plasma ceramide concentrations were obtained from medical records in this retrospective study.

C16:0-Cer and C18:0-Cer levels, along with CERT1 score, were significantly elevated in SAP patients compared with non-SAP patients.

• Among the four ceramide subspecies measured, C16:0-Cer and C18:0-Cer specifically differentiated SAP from non-SAP patients within the AIS cohort.
• C24:1-Cer and C24:0-Cer did not significantly differ between SAP and non-SAP patients.
• CERT1 score was also significantly higher in SAP compared to non-SAP patients.
• Comparisons were conducted before and after propensity score matching.

C16:0-Cer, C18:0-Cer, and CERT1 score were positively correlated with stroke severity as measured by NIHSS and mRS scores.

• Levels of C16:0-Cer, C18:0-Cer, and CERT1 score were positively correlated with both the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS) scores.
• Patients with minor ischemic stroke had lower levels of C16:0-Cer, C18:0-Cer, and CERT1 score compared with those with moderate and severe ischemic stroke.
• This suggests ceramide levels track with neurological deficit severity.

The A2DS2 score, C16:0-Cer, high-sensitivity C-reactive protein (hs-CRP), and neutrophil-to-lymphocyte ratio (NLR) were identified as independent risk factors for SAP.

• LASSO regression was used to select variables prior to multivariate analysis.
• Multivariate analysis identified four independent risk factors for SAP: A2DS2 score, C16:0-Cer, hs-CRP, and neutrophil-to-lymphocyte ratio.
• The inclusion of both inflammatory markers (hs-CRP, NLR) and a ceramide subspecies (C16:0-Cer) suggests overlapping inflammatory and sphingolipid pathways in SAP risk.

C16:0-Cer demonstrated moderate predictive accuracy for SAP with an AUC of 0.725, sensitivity of 74.0%, and specificity of 61.2%.

• Predictive values were evaluated using receiver operating characteristic (ROC) curves.
• C16:0-Cer achieved an area under the curve (AUC) of 0.725 for predicting SAP.
• The sensitivity was 74.0% and specificity was 61.2% at the optimal cut-off.
• The authors described this as 'moderate predictive accuracy,' suggesting potential as a novel biomarker for early SAP risk stratification.