AIM To explore the predictive value of interleukin-33 (IL-33) mRNA and its receptor soluble matrix lysin 2 (sST2) mRNA in the occurrence of thrombosis in patients with non-valvular atrial fibrillation (NVAF) after anticoagulation therapy.

METHODS A total of 340 patients with NVAF anticoagulation who were admitted to the 940th Hospital of Joint Logistics Support Force of PLA from February 2023 to March 2024 were selected as the research subjects. According to the end-point events during the follow-up period, the subjects were divided into thrombotic event groups (n=33 cases) and the event-free group (n=307 cases). In addition, 100 healthy people who had physical examinations during the same period were selected as the control group. Real-time fluorescent quantitative polymerase chain reaction (RT-PCR) was used to determine the expression of IL-33 mRNA and sST2 mRNA in the peripheral blood of the subjects. The differences in the expression of IL-33 mRNA and sST2 mRNA in the three groups were also compared. Meanwhile, the receiver operating characteristic (ROC) curve was used to evaluate the performance of IL-33 mRNA and sST2 mRNA in predicting thrombotic events. Logistic regression was used to obtain odds ratio (OR), and COX proportional hazard regression model was used to obtain the hazard ratio (HR).

RESULTS  Compared with the control group, the expression of IL-33 mRNA and sST2 mRNA was significantly increased in the NVAF group and its two subgroups (thrombotic event group and no event group) (both P<0.01); The expression of IL-33 mRNA and sST2 mRNA in the thrombotic event group was significantly higher than that in the non event group and the NVAF group (both P<0.01). The AUC of predicting thrombotic events in NVAF patients within 3 months using peripheral blood IL-33 mRNA and sST2 mRNA were 0.823 and 0.802, respectively, while the AUC for combined diagnosis was 0.923, with a sensitivity of 88.16% and specificity of 85.58%, both higher than individual indicators; The results of univariate analysis showed that IL-33 mRNA and sST2 mRNA in the peripheral blood of NVAF patients were significantly correlated with age, ischemic events, vascular diseases, hypertension, type 2 diabetes and chronic heart failure (all P<0.01), while there was no significant correlation with gender, anticoagulant drug type and drug compliance. Multiple logistic regression analysis showed that IL-33 mRNA and sST2 mRNA were significantly correlated with ischemic events, vascular diseases, hypertension, type 2 diabetes and chronic heart failure (all P<0.01), but there was no significant correlation with age. The COX regression model results showed that the relative HR of thrombotic events within 3 months were 0.773 and 0.801 for those whose peripheral blood IL-33 mRNA and sST2 mRNA expression did not exceed the critical value and those who exceeded the critical value, respectively. When the two were combined for prediction, the relative HR of thrombotic events was 0.734, which can effectively identify thrombotic events.

CONCLUSION The changes in the expression of IL-33 mRNA and sST2 mRNA in the peripheral blood of NVAF anticoagulation patients are related to a variety of clinicopathological factors, and are closely related to the risk of thrombosis, which provide references for the prediction of thrombosis in such patients.