Elevated plasma macrophage migration inhibitor factor as a risk factor for the development of post-stroke depression in ischemic stroke

Macrophage migration inhibitory factor (MIF), a central cytokine of the innate immunity and inflammatory responses, has been reported to link to the pathophysiology of cardiovascular disease and depression. In this study, 333 stroke patients were included, and 95 out of those patients (28.5%) were classified as major depression. For each 1unit increase of MIF, the unadjusted and adjusted risk of post-stroke depression (PSD) increased by 18% (OR: 1.18; 95% CI, 1.13-1.23, P < 0.001) and 11% (1.11; 1.02-1.16, P = 0.001), respectively. Using ROC curves, MIF level at 21.5 ng/ml predicted the development of depression at 3 months with the highest sensitivity and specificity [88.4% and 58.4%, respectively; area under the curve (AUC) =0.79, 95%CI: 0.74-0.85; P < 0.001]. MIF levels had a higher prognostic accuracy as compared to CRP [AUC 0.58 (0.51-0.65), P < 0.001], HCY [AUC 0.64 (0.58-0.71), P < 0.0001] and IL-6 [AUC 0.74 (0.68-0.80), P = 0.001]. See the figure. The present study demonstrated that elevated levels of MIF at admission were associated with increased risk of PSD in the next three months and might be useful in identifying stroke at risk for PSD for early prevention strategies.52