Peripheral tumor necrosis factor-a-induced protein 8-like 2 mRNA level for predicting 3-month mortality of patients with acute ischemic stroke

Abstract

Tumor necrosis factor-a-induced protein 8-like 2 (TIPE2) is a novel negative regulator for maintaining immune homeostasis. This study aimed to investigate TIPE2 mRNA in peripheral blood mononuclear cells for predicting 3-month functional outcomes and mortality of patients with acute ischemic stroke. A total of 182 consecutive patients were prospective collected, and there were 55 (30.2%) patients with unfavorable outcome and 33 (18.1%) patients died at the end of 3 months. The area under the operating characteristic curve (AUC) for TIPE2 mRNA was 0.810 (95% CI 0.733-0.886) for mortality and 0.740 (95% CI 0.662-0.818) for unfavorable outcome. The model incorporating National Institutes of Health Stroke Scale (NIHSS) plus TIPE2 showed significantly (P = 0.04) increased discrimination power (AUC = 0.925, 95% CI 0.874-0.976) for mortality than NIHSS (AUC = 0.882, 95% CI 0.833-0.932). Furthermore, NIHSS plus TIPE2 showed a significant improvement of both integrated discrimination index (IDI) and net reclassification index (NRI) as compared with NIHSS (IDI = 0.224, 95% CI 0.150-0.299, P < 0.001; NRI = 1.119, 95% CI 0.810-1.429, P < 0.001). The pruned time-dependent tree analysis showed that patients with NIHSS ≥ 5.5 and TIPE2 mRNA < 5.2 had rather high 3-month mortality. In conclusion, TIPE2 mRNA improved the diagnostic value of NIHSS score, and patients with NIHSS ≥ 5.5 and TIPE2 mRNA < 5.2 had high 3-month mortality.

Keywords: Acute ischemic stroke; Biomarker; Functional outcome; Mortality; Tumor necrosis factor-a-induced protein 8-like 2.