ABSTRACT NUMBER: ESOC2026A1209 TEMPORAL PROFILE OF SOLUBLE TOLL-LIKE RECEPTOR 4 AND ITS ASSOCIATION WITH INTRACEREBRAL HAEMORRHAGE EXPANSION

Abstract Background and aims This study aimed to characterise the temporal profile of soluble Toll-like receptor 4 (sTLR4) during the acute phase of spontaneous intracerebral haemorrhage (ICH) and to evaluate its potential association with haematoma expansion (HE). Methods We analysed serum sTLR4 concentrations in 99 patients with primary hemispheric ICH within 12 hours of symptom onset. Measurements were obtained at admission, 24, and 72 hours using enzyme-linked immunosorbent assay (ELISA), with 39 non-stroke individuals serving as controls. HE was defined as an increase in haematoma volume >6 mL or >33% on follow-up brain CT at 24 hours. Longitudinal sTLR4 fluctuations were evaluated through linear mixed-effects models. Independent predictors of HE were identified using multivariable logistic regression, and model performance was assessed via the area under the receiver operating characteristic curve (AUC-ROC). Results ICH patients showed significantly higher baseline sTLR4 levels compared to controls, followed by a time-dependent decline. Notably, patients with HE demonstrated higher admission sTLR4 levels than those without HE (2.50 [95% CI: 1.84–3.16] vs. 1.62 [95% CI: 1.22–2.02] ng/mL, p=0.027). Furthermore, while the non-HE group showed a rapid decrease within the first 24 hours, the HE group maintained elevated levels with a more gradual decline. Baseline sTLR4 was independently associated with HE and a multivariable model incorporating sTLR4, admission NIHSS, and ICH location achieved an AUC of 0.753, yielding a negative predictive value of 90.4%. Conclusions sTLR4 may be involved in the pathophysiology of HE. Specifically, baseline sTLR4 levels serve as a robust biomarker to identify patients at low risk of HE. Conflict of interest Maria Lucas Parra: nothing to disclose