Plasma SIRT3 as a Biomarker of Severity and Prognosis After Acute Intracerebral Hemorrhage: A Prospective Cohort Study

Abstract

Objective

SIRT3 may act as a brain-protective factor. We measured the plasma SIRT3 levels of patients with intracerebral hemorrhage (ICH) and further determined the relationship between plasma SIRT3 and clinical outcome plus severity of ICH.

Methods

In this prospective cohort study, we quantified plasma SIRT3 levels in 105 ICH patients and 72 healthy controls. Glasgow Coma Scale (GCS) score and hematoma volume were used to assess severity. Poor prognosis was defined as a Glasgow Outcome Scale (GOS) score of 1–3 at 90 days after ICH.

Results

Plasma SIRT3 levels were markedly lower in patients than in controls (median, 10.19 versus 13.17 ng/mL; P<0.001). Among all patients, plasma SIRT3 levels were independently correlated with hematoma volume (beta, −0.098; 95% confidence interval, −0.158--0.039; t, −3.282; P=0.001) and GCS score (beta, 0.465; 95% confidence interval, 0.107–0.823; t, 2.576; P=0.011). A total of 46 cases had a poor prognosis at post-stroke 90 days. The plasma levels of SIRT3 significantly decreased in patients with a poor prognosis, compared with those with a good prognosis (median, 6.1 versus 11.2 ng/mL; P<0.001). Plasma SIRT3 was an independent predictor for 90-day poor prognosis of patients (odds ratio, 0.837; 95% confidence interval, 0.708–0.990; P=0.038). Plasma SIRT3 levels distinguished the development of poor prognosis with area under receiver operating characteristic curve at 0.801 (95% confidence interval, 0.711–0.872) and plasma SIRT3 levels ≤7.38 ng/mL predicted poor prognosis with 63.04% sensitivity and 93.22% specificity.

Conclusion

Declined plasma SIRT3 levels are highly associated with hemorrhagic severity and poor 90-day outcome, thus suggesting that plasma SIRT3 may serve as a potential prognostic biomarker for ICH.

Keywords:

• intracerebral hemorrhage
• prognosis
• severity
• SIRT3
• outcome

Abbreviations

GCS, Glasgow Coma Scale; ICH, intracerebral hemorrhage; CT, computerized tomography; ROC, receiver operating characteristic; AUC, area under curve; 95% CI, 95% confidence interval; ROS, reactive oxygen species.

Data Sharing Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Acknowledgments

The authors thank all staffs in Department of Neurosurgery, the Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine (Hangzhou, China) for their technical support.

Disclosure

The authors have no conflicts of interest in this work.

Additional information

Funding

This work is financially supported by Key Research and Development Projects of Zhejiang Province (No. 2020C03071) and the Construction Fund of Medical Key Disciplines of Hangzhou (No. OO20200485, No. OO20200055).