Abstract:

Objective To explore the predictive value of milk fat globule-epidermal growth factor 8 (MFG-E8) in cognitive impairment after ischemic stroke (IS). Methods A prospective nested case-control study was conducted, involving 135 IS patients admitted to Shanghai Baoshan District Wusong Central Hospital, from January 2021 to January 2023 as the case group. During the same period, 135 healthy individuals who underwent physical examinations in our hospital were included in the control group. All patients in the case group were treated conservatively and evaluated for their cognitive function 6 months after discharge using the Montreal cognitive assessment basic scale(MoCA). They were assigned into the normal cognition group(n=78) and impaired cognition group(n=52) based on the MoCA scores. Furthermore, patients in the impaired cognition group were sub-divided into mild group, moderate to severe group. Clinical data of patients in the case group were collected. Serum MFG-E8 levels of the patients were measured before clinical treatment, 7 days after admission and at discharge. The efficacy of serum MFG-E8 levels on predicting cognitive dysfunction after IS was analyzed. Results After excluding 5 patients in the case group, finally a total of 130 eligible patients in the case group were included for the analysis. Serum MFG-E8 levels in the case group before treatment were significantly lower than those in the control group (P<0.01). Cognition impairment was detected in 52 (40.0%) patients in the case group, including 34 cases of mild cognitive impairment, 16 cases of moderate cognitive impairment, and 2 cases of severe cognitive impairment. Serum MFG-E8 levels, changes in serum MFG-E8 from before clinical treatment to 7 days of admission (△₁MFG-E8), and changes in serum MFG-E8 from before clinical treatment to discharge (△₂MFG-E8) in the impaired cognition group at all time points were significantly lower than those of the normal cognition group (P<0.05). Serum MFG-E8 levels in the moderate and severe groups were significantly lower than those of the mild group before treatment, 7 days after admission, and at discharge (P<0.05). The results of logistic regression analysis showed that serum MFG-E8 levels, Δ1MFG-E8, Δ2MFG-E8, infarction in the frontal lobe and moderate infarction size before treatment, 7 days of admission and at discharge were significantly correlated with cognitive dysfunction after IS (P<0.05). The receiver operating characteristic (ROC) curve showed that the △₂MFG-E8 value had a better predictive effect on cognitive impairment after IS, with an area under the curve of 0.895(95%CI: 0.843-0.947), sensitivity of 74.4% and specificity of 88.5%. Conclusion Serum MFG-E8 levels have a high predictive value in cognitive dysfunction in IS patients, and the changes in serum MFG-E8 at discharge are effective in predicting cognitive dysfunction after IS.

Key words: stroke, cognitive impairment, milk fat globule-epidermal growth factor 8