In the game of life, serum Nrf2 is a MVP (most valuable protein)! This study dives into the role of Nrf2 in acute supratentorial intracerebral hemorrhage (ICH) and its impact on patient prognosis. Think of Nrf2 as the captain of the antioxidant response team. Elevated Nrf2 levels were found in ICH patients compared to controls, peaking between 12-18 hours after stroke onset. These elevated levels were associated with increased severity of stroke, early neurological deterioration (END), and a poor outcome at 90 days. In fact, serum Nrf2 was shown to be just as effective at predicting END and poor outcome as the National Institutes of Health Stroke Scale (NIHSS) score and hematoma volume. And when combined with these factors, Nrf2 improved their predictive abilities even further! Could serum Nrf2 serve as a valuable biomarker for ICH? This study opens up a whole new avenue of research to explore the potential of Nrf2 in acute brain injury after ICH.

ObjectiveNuclear factor erythroid 2-related factor 2 (Nrf2) is a key transcriptional factor for antioxidant response element-regulated genes. The purpose of this study was to assess the prognostic role of serum Nrf2 in intracerebral hemorrhage (ICH).Materials and methodsIn this prospective observational study, serum Nrf2 levels of 115 acute supratentorial ICH patients and 115 controls were gaged. Early neurologic deterioration (END) was defined as an increase of four or greater points in National Institutes of Health Stroke Scale (NIHSS) score or death at post-stroke 24 h. A poor outcome was referred to as the post-stroke 90-day modified Rankin scale (mRS) score of 3–6. END and a poor outcome were considered as the two prognostic parameters.ResultsAs compared to controls, serum Nrf2 levels of patients were substantially elevated (P < 0.001), with its levels increasing during the 6-h period immediately, peaking in 12–18 h, plateauing at 18–24 h, and decreasing gradually thereafter (P < 0.05). Serum Nrf2 levels of patients were independently correlated with NIHSS score (t = 3.033; P = 0.003) and hematoma volume (t = 3.210; P = 0.002), independently predicted END (odds ratio 1.125; 95% confidence interval 1.027–1.232; P = 0.011) and poor outcome (odds ratio 1.217; 95% confidence interval 1.067–1.387; P = 0.013), as well as efficiently distinguished END (area under curve 0.771; 95% confidence interval 0.666–0.877; P < 0.001) and poor outcome (area under curve 0.803; 95% confidence interval 0.725–0.882; P < 0.001). Its predictive ability was equivalent to those of NIHSS score and hematoma volume (both P > 0.05), and it also significantly improved their predictive abilities under receiver operating characteristic (ROC) curve (all P < 0.05).ConclusionElevated serum Nrf2 levels are closely correlated with severity, END, and 90-day poor outcome following ICH. Hence, Nrf2 may play an important role in acute brain injury after ICH, and serum Nrf2 may have the potential to serve as a prognostic biomarker of ICH.

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