Serum Transcription Factor EB Levels in Relation to Poor Neurological Prognosis and Mediation Effect of Stroke-Associated Pneumonia in Acute Intracerebral Hemorrhage: Evidence from a Two-Center Prospective Cohort Study

Kang Wang,1 Guoyong Zhan,1 Qingsong Jiang,1 Cai Jiang,1 Guofu Zheng,1 Zhuxiao Tang2 1Department of Neurosurgery, QuZhou KeCheng People’s Hospital, Quzhou, Zhejiang Province, People’s Republic of China; 2Brain Center, Zhejiang Hospital, Hangzhou, Zhejiang Province, People’s Republic of ChinaCorrespondence: Guoyong Zhan, Department of Neurosurgery, QuZhou KeCheng People’s Hospital, Quzhou, Zhejiang Province, People’s Republic of China, Email [email protected]: Transcription factor EB (TFEB) is an endogenous protective protein. Serum TFEB levels were measured after acute intracerebral hemorrhage (ICH), in addition to determining their connection to the severity and neurological outcomes of patients.Methods: Serum TFEB levels were measured in a prospective cohort study of 186 ICH patients and 100 controls. Severity was estimated using the National Institutes of Health Stroke Scale (NIHSS) and hematoma volume. Poor neurological status mirrored by the post-ICH six-month modified Rankin Scale (mRS), along with stroke-associated pneumonia (SAP), was considered as the two outcome variables.Results: Patients showed a marked decline in serum TFEB levels compared with controls. Serum TFEB levels were significantly inversely correlated with both NIHSS scores and hematoma volume; had a linear relationship with likelihoods of both SAP and poor prognosis (mRS scores 3– 6), were independent of ordinal mRS scores, SAP, and poor prognosis; and were efficiently predictive of SAP and poor prognosis with analogous areas under the receiver operating characteristic curve as NIHSS scores and hematoma volume. The association between serum TFEB levels and poor prognosis is partly mediated by SAP.Conclusion: Reduced serum TFEB levels post-ICH of evident relevance to bleeding intensity are powerfully linked to poor neurological prognosis, wherein there is a partial mediative effect by SAP, thereby reinforcing TFEB as a serological prognostic indicator of good prospect in ICH.Keywords: transcription factor EB, intracerebral hemorrhage, outcome, severity, stroke-associated pneumonia, biomarkers