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Association of Serum Macrophage Migration Inhibitory Factor with 3-Month Poor Outcome and Malignant Cerebral Edema in
Wen Guo1,2, Mangmang Xu1, Xindi Song1
1Center of Cerebrovascular Disease, Department of Neurology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, People's Republic of China.
Background:
We aimed to investigate the associations of macrophage migration inhibitory factor (MIF), toll-like receptors 2 and 4 (TLR2/4), and matrix metalloproteinase 9 (MMP9) with 3-month poor outcome, death, and malignant cerebral edema (MCE) in patients with large hemispheric infarction (LHI).
Methods:
Patients with LHI within 24 h of onset were enrolled consecutively. Serum MIF, TLR2/4, and MMP9 concentrations on admission were measured. Poor outcome was defined as a modified Rankin Scale score of ≥ 3 at 3 months. MCE was defined as a decreased level of consciousness, anisocoria and midline shift > 5 mm or basal cistern effacement, or indications for decompressive craniectomy during hospitalization. The cutoff values for MIF/MMP9 were obtained from the receiver operating characteristic curve.
Results:
Of the 130 patients with LHI enrolled, 90 patients (69.2%) had 3-month poor outcome, and MCE occurred in 55 patients (42.3%). Patients with serum MIF concentrations ≤ 7.82 ng/mL for predicting 3-month poor outcome [adjusted odds ratio (OR) 2.827, 95% confidence interval (CI) 1.144-6.990, p = 0.024] also distinguished death (adjusted OR 4.329, 95% CI 1.841-10.178, p = 0.001). Similarly, MMP9 concentrations ≤ 46.56 ng/mL for predicting 3-month poor outcome (adjusted OR 2.814, 95% CI 1.236-6.406, p = 0.014) also distinguished 3-month death (adjusted OR 3.845, 95% CI 1.534-9.637, p = 0.004).
Conclusions:
Lower serum MIF and MMP9 concentrations at an early stage were independently associated with 3-month poor outcomes and death in patients with LHI. These findings need further confirmation in larger sample studies.
Insights
Lower levels of macrophage migration inhibitory factor (MIF) and matrix metalloproteinase 9 (MMP9) in patients with large hemispheric infarction (LHI) are linked to worse outcomes and death within three months. Further research is needed to confirm these findings.
Area of Science:
- Neurology
- Biochemistry
- Immunology
Background:
- Large hemispheric infarction (LHI) is a severe condition with significant mortality and morbidity.
- Investigating biomarkers associated with LHI outcomes is crucial for early intervention.
- Macrophage migration inhibitory factor (MIF), toll-like receptors 2 and 4 (TLR2/4), and matrix metalloproteinase 9 (MMP9) are implicated in inflammatory and tissue remodeling processes relevant to stroke.
Purpose of the Study:
- To examine the association between serum concentrations of MIF, TLR2/4, and MMP9 and 3-month outcomes in patients with LHI.
- To determine if these biomarkers predict poor outcome, death, or malignant cerebral edema (MCE) following LHI.
Main Methods:
- Consecutive enrollment of LHI patients within 24 hours of symptom onset.
- Measurement of serum MIF, TLR2/4, and MMP9 levels upon admission.
- Assessment of 3-month outcomes using modified Rankin Scale (mRS) and clinical criteria for MCE.
- Utilized receiver operating characteristic (ROC) curves to establish cutoff values for MIF and MMP9.
Main Results:
- Out of 130 LHI patients, 69.2% experienced poor 3-month outcomes and 42.3% developed MCE.
- Lower serum MIF concentrations (≤7.82 ng/mL) were significantly associated with increased odds of 3-month poor outcome (OR 2.827) and death (OR 4.329).
- Lower serum MMP9 concentrations (≤46.56 ng/mL) were also independently linked to higher odds of 3-month poor outcome (OR 2.814) and death (OR 3.845).
Conclusions:
- Early-stage lower serum MIF and MMP9 concentrations are independent predictors of adverse 3-month outcomes and mortality in LHI patients.
- These biomarkers may serve as potential prognostic indicators for LHI.
- Larger studies are warranted to validate these associations and explore clinical applications.
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