Yong Cai, Yijun Ma, Chao Tang, Wei Li, Xuan Lv, Zhijie Xie, Jun Wang

Department of Neurosurgery, First People’s Hospital of Linping District, Hangzhou, Zhejiang, People’s Republic of China

Correspondence: Jun Wang, Department of Neurosurgery, The First People’s Hospital of Linping District, Hangzhou, Zhejiang, People’s Republic of China, Email wangjun57188@163.com

Background: Nucleotide-binding oligomerization domain-like receptor family pyrin domain-containing 3 (NLRP3) is involved in secondary brain injury after acute intracerebral hemorrhage (ICH). The objective of this study was to determine its ability to predict early neurological deterioration (END) and 3-month neurological outcome after ICH.
Methods: In this prospective cohort study, serum NLRP3 levels were measured in 128 patients with sICH and 100 healthy controls. National institute of health stroke scale (NIHSS) scores and hematoma volumes were recorded. Post-ICH END and 3-month poor outcome (modified Rankin Scale (mRS) scores of 3– 6) were documented. The results were assessed using multivariate analysis.
Results: Serum NLRP3 levels in sICH patients increased significantly as compared to controls (P< 0.001). Serum NLRP3 levels were independently correlated with hematoma volumes (β=0.046; 95% confidence interval (CI), 0.020– 0.072; P=0.001) and NIHSS scores (β=0.071; 95% CI, 0.004– 0.139; P=0.039), independently forecasted END (OR=1.268; 95% CI, 0.892– 1.801; P=0.036) and poor prognosis at post-ICH 3 months (OR=1.448; 95% CI, 1.006– 2.085; P=0.046), and were predictive of them with areas under receiver operating characteristic curve at 0.788 (95% CI, 0.706– 0.855) and 0.805 (95% CI, 0.725– 0.870) separately. Serum NLRP3 levels, along with the two independent predictors, that are NIHSS scores and hematoma volumes, are combined to establish prediction models of END and poor prognosis. The models worked well by applying a series of statistical methods.
Conclusion: Increased serum NLRP3 levels after ICH are independently associated with bleeding severity, END and adverse outcomes of patients, meaning that serum NLRP3 may be a potential prognostic biomarker of sICH.

Keywords: intracerebral hemorrhage, disease severity, early neurological deterioration, outcome, NLRP3