Prognostic value of serum thioredoxin concentrations after intracerebral hemorrhage

Thioredoxin (TRX) is a potent anti-oxidant and its circulating concentration is increased in some critical illnesses. We measured the serum TRX concentrations and further investigated the relationship between serum TRX concentrations and hemorrhagic severity and outcome after intracerebral hemorrhage (ICH).

A total of 218 ICH patients and 218 healthy controls were enrolled in this prospective, observatory study. Serum TRX concentrations were determined using an enzyme-linked immunosorbent assay. Hemorrhagic severity was assessed with National Institutes of Health Stroke Scale (NIHSS) score and hematoma volume. Clinical endpoint was 6-month mortality.

Compared with the controls, the patients had elevation of serum TRX concentrations (24.4±11.5 ng/ml vs. 8.4±3.3 ng/ml, P<0.001). Serum TRX concentrations were highly related to NIHSS score (r=0.532, P<0.001) and hematoma volume (r=0.486, P<0.001). Serum TRX concentrations higher than 29.6 ng/ml was an independent predictor of 6-month mortality (odds ratio, 3.978; 95% confidence interval, 1.486-10.649) and 6-month overall survival (hazard ratio, 3.511; 95% confidence interval, 1.827-6.746). TRX concentrations improved the predictive value of NIHSS score and hematoma volume for 6-month mortality.

Increased serum TRX concentration, related closely to hemorrhagic severity and long-term mortality, has the potential to be a novel prognostic predictive biomarker after ICH.