Scherrer Natalie, Fays Francois, Mueller Beat, Luft Andreas, Fluri Felix, Christ-Crain Mirjam, Devaux Yvan, Katan Mira
Department of Neurology, University Hospital of Zurich, Zurich, Switzerland.
Competence Center in Methodology and Statistics, Luxembourg Institute of Health, Strassen, Luxembourg.
J Stroke. 2017 Sep;19(3):323-332. doi: 10.5853/jos.2017.00423. Epub 2017 Sep 29.
Micro ribonucleic acid-150-5p (miR-150-5p) regulates proinflammatory cytokines as well as vessel integrity. We evaluated the incremental prognostic value of logarithm (log) of miR-150-5p plasma levels after ischemic stroke.
In a prospective cohort study, levels of miR-150-5p were measured within 72 hours of symptom onset in 329 ischemic stroke patients. The outcome measures were unfavorable functional outcome (assessed by the modified Rankin Scale score >2) and mortality within 90 days. Logistic regression and Cox proportional hazards models were fitted to estimate odds ratio (OR), respectively hazard ratio (HR) and 95% confidence interval (CI) for the association between log-miR-150-5p and the outcome measures. The discriminatory accuracy was assessed with the area under the receiver-operating-characteristic curve (AUC) and the incremental prognostic value was estimated with the net reclassification index.
After adjusting for demographic and vascular risk factors, lower log-miR-150-5p levels were independently associated with mortality (HR 0.21 [95% CI, 0.08-0.51], =0.001) but not functional outcome (OR 1.10 [95% CI, 0.54-2.25], =0.79). Adding log-miR-150-5p improved the discriminatory accuracy of the best multivariate model to predict mortality from an AUC of 0.91 (95% CI, 0.88-0.95) to 0.92 (95% CI, 0.88-0.96 Likelihood-ratio test-<0.001), and resulted in a net reclassification index of 37.3% (95% CI, 0.28-0.52).
In patients with ischemic stroke, log-miR-150-5p is a novel prognostic biomarker, highly associated with mortality within 90 days, improving risk classification beyond traditional risk factors.
微小核糖核酸 - 150 - 5p（miR - 150 - 5p）可调节促炎细胞因子以及血管完整性。我们评估了缺血性卒中后miR - 150 - 5p血浆水平的对数（log）的增量预后价值。
在一项前瞻性队列研究中，对329例缺血性卒中患者在症状发作后72小时内测量miR - 150 - 5p水平。结局指标为不良功能结局（通过改良Rankin量表评分>2评估）和90天内死亡率。采用逻辑回归和Cox比例风险模型分别估计log - miR - 150 - 5p与结局指标之间关联的比值比（OR）、风险比（HR）和95%置信区间（CI）。通过受试者工作特征曲线下面积（AUC）评估判别准确性，并通过净重新分类指数估计增量预后价值。
在调整人口统计学和血管危险因素后，较低的log - miR - 150 - 5p水平与死亡率独立相关（HR 0.21 [95% CI，0.08 - 0.51]，P = 0.001），但与功能结局无关（OR 1.10 [95% CI，0.54 - 2.25]，P = 0.79）。添加log - miR - 150 - 5p可将预测死亡率的最佳多变量模型的判别准确性从AUC为0.91（95% CI，0.88 - 0.95）提高到0.92（95% CI，0.88 - 0.96；似然比检验P<0.001），并导致净重新分类指数为37.3%（95% CI，0.28 - 0.52）。
在缺血性卒中患者中，log - miR - 150 - 5p是一种新型的预后生物标志物，与90天内死亡率高度相关，可改善传统危险因素以外的风险分类。
