Ma Yijun, Wang Jun, Tang Chao, Li Wei, Lv Xuan, Zhu Suijun
Department of Neurosurgery, First People's Hospital of Linping District, Hangzhou, China.
Department of Neurosurgery, Linping Campus, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
Front Neurol. 2024 Sep 13;15:1436997. doi: 10.3389/fneur.2024.1436997. eCollection 2024.
Interleukin-1 receptor-associated kinase 3 (IRAK3) modulates neuroinflammation. This study aimed to determine the prognostic role of serum IRAK3 in acute intracerebral hemorrhage (ICH).
In this prospective observational cohort study, 152 patients with supratentorial ICH, along with 63 healthy controls, were recruited. Serum IRAK3 levels were measured at the time of enrollment for controls, at admission for all patients, and on poststroke days 1, 3, 5, 7, 10, and 15 in a subset of 63 patients. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) and hematoma volume. Poststroke 6-month modified Rankin Scale (mRS) scores were registered, with scores of 3-6 representing a poor prognosis. Multivariate models were established to investigate severity correlation and prognosis association.
Serum IRAK3 levels were significantly elevated at the admission of patients, peaked at day 1, plateaued at day 3, gradually declined until day 15, and were substantially higher over the first 15 days poststroke than in controls. Admission serum IRAK3 levels were independently associated with NIHSS scores, hematoma volume, and 6-month mRS scores in a multivariate linear regression model. They were linearly correlated with the risk of poor prognosis in a restricted cubic spline analysis and were independently predictive of poor prognosis in a binary logistic regression model. Additionally, they demonstrated strong prognostic ability in the receiver operating characteristic curve analysis. Using subgroup analysis, no interactions were found between admission serum IRAK3 levels and some routine variables, such as age, gender, hypertension, and diabetes mellitus. Moreover, the model combining admission serum IRAK3, NIHSS scores, and hematoma volume demonstrated stability and clinical value in calibration and decision curve analyses.
A significant increase in erum IRAK3 levels during the early phase after ICH, strongly correlated with disease severity, is independently associated with a poor 6-month prognosis, establishing serum IRAK3 as a valuable prognostic biomarker for ICH.
白细胞介素-1受体相关激酶3（IRAK3）调节神经炎症。本研究旨在确定血清IRAK3在急性脑出血（ICH）中的预后作用。
在这项前瞻性观察性队列研究中，招募了152例幕上脑出血患者以及63名健康对照者。对照组在入组时、所有患者在入院时以及63例患者亚组在卒中后第1、3、5、7、10和15天测量血清IRAK3水平。使用美国国立卫生研究院卒中量表（NIHSS）和血肿体积评估卒中严重程度。记录卒中后6个月的改良Rankin量表（mRS）评分，评分3 - 6表示预后不良。建立多变量模型以研究严重程度相关性和预后关联性。
患者入院时血清IRAK3水平显著升高，在第1天达到峰值，第3天趋于平稳，直至第15天逐渐下降，且卒中后前15天显著高于对照组。在多变量线性回归模型中，入院时血清IRAK3水平与NIHSS评分、血肿体积和6个月mRS评分独立相关。在受限立方样条分析中，它们与预后不良风险呈线性相关，在二元逻辑回归模型中独立预测预后不良。此外，在受试者工作特征曲线分析中，它们显示出很强的预后能力。通过亚组分析，未发现入院时血清IRAK3水平与年龄、性别、高血压和糖尿病等一些常规变量之间存在相互作用。此外，结合入院时血清IRAK3、NIHSS评分和血肿体积的模型在校准和决策曲线分析中显示出稳定性和临床价值。
脑出血后早期血清IRAK3水平显著升高，与疾病严重程度密切相关，独立与6个月预后不良相关，确立血清IRAK3为脑出血有价值的预后生物标志物。
