Serum Peroxiredoxin 6 Levels and Clinical Outcomes After Acute Intracerebral Hemorrhage in Elderly Patients: A Multicenter Observational Analytical Study

Tiancheng Lu,1 Boren Zheng,1 Dongyao Wang,1 Weihao Liao,1 Chang Su,2 Xiaoyu Wu,2 Xiaojun Zhong,3 Xinle Chen,3 Guozheng Ying,3 Yong Cai,4 Quan Du,5 Xiaoqiao Dong5 1The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China; 2Department of Neurosurgery, Lishui Hospital of Wenzhou Medical University, Lishui, People’s Republic of China; 3Department of Neurosurgery, Third Affiliated Hospital of Jiaxing University, Jiaxing, People’s Republic of China; 4Department of Neurosurgery, Linping Campus, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, People’s Republic of China; 5Department of Neurosurgery, Affiliated Hangzhou First People’s Hospital, Westlake University School of Medicine, Hangzhou, People’s Republic of ChinaCorrespondence: Xiaoqiao Dong, Department of Neurosurgery, Affiliated Hangzhou First People’s Hospital, Westlake University School of Medicine, Hangzhou, People’s Republic of China, Email dongxiaoqiao@hospital.westlake.edu.cnBackground: Intracerebral hemorrhage (ICH) is commonly encountered in elderly patients. Peroxiredoxin 6 (Prx6) is involved in oxidative stress and inflammatory responses. Here, serum Prx6 levels were measured to explore their prognostic value in ICH.Methods: In this multicenter observational analytical study of 306 elderly patients with ICH and 100 elderly controls, serum Prx6 levels were quantified at admission of all patients, at serial time points of 103 patients and at study entry of controls. Outcome variables included early neurological deterioration (END) and poor neurological status mirrored by six-month modified Rankin Scale (mRS).Results: Serum Prx6 levels were significantly elevated upon admission of patients, gradually increased on day 1, peaked on day 3, decreased from day 5 until day 14 after ICH, and were markedly higher during 14 days than those of controls. Serum Prx6 levels, in independent correlation with National Institutes of Health Stroke Scale scores, hematoma sizes and mRS scores, were linearly related to risks of END and poor prognosis, and independently predicted their occurrences. The independent associations were robust in sensitivity analysis. The association between serum Prx6 levels and poor prognosis was partially mediated by END. Serum Prx6 levels showed an effective predictive ability for poor prognosis and END. Other parameters, such as age, gender, and hypertension, negligibly affected the relevance of Prx6 levels in poor prognosis and END. The combined models encompassing independent predictors were visualized via the nomograms and had acceptable goodness of fit and clinical benefit via various statistical tools.Conclusion: Elevated serum Prx6 levels post-ICH in the elderly are intimately related to bleeding severity and clinical outcomes; and END partially interprets the association of serum Prx6 with poor prognosis, therefore suggesting that serum Prx6 may be a prognostic biomarker of ICH in the elderly.Keywords: peroxiredoxin 6, intracerebral hemorrhage, prognosis, severity, biomarkers, elderly