Association of 5-HT, ET-1, PTX-3, and inflammatory markers with clinical parameters in pediatric migraine patients with patent foramen ovale.

BACKGROUND

Pediatric migraine is a debilitating neurological disorder frequently associated with patent foramen ovale (PFO). The roles of vasoactive substances (5-HT, ET-1) and inflammatory markers (PTX-3, TNF-α, CRP) in PFO-related pediatric migraine remain unclear. This study aimed to evaluate their predictive value and associations with clinical parameters.

METHODS

A prospective cohort study enrolled 149 PFO patients (78 with pediatric migraine, 71 without) and 70 healthy controls. Serum levels of 5-HT, ET-1, PTX-3, TNF-α, PCT, and CRP were measured using ELISA. Clinical data, including pediatric migraine characteristics and PFO features (diameter, right-to-left shunt), were analyzed. Receiver operating characteristic (ROC) curves assessed biomarker performance, and logistic regression identified risk factors.

RESULTS

5-HT showed the highest individual predictive accuracy for pediatric migraine (AUC = 0.810), followed by PCT (AUC = 0.786) and PTX-3 (AUC = 0.707). ET-1 exhibited high specificity (99.1 %), while TNF-α and CRP demonstrated high sensitivity (91.1 %). A combined biomarker panel achieved superior performance (AUC = 0.911, specificity = 94.4 %). Elevated 5-HT (adjusted OR = 1.593, p = 0.026) and PTX-3 (adjusted OR = 1.752, p = 0.014) levels were independently associated with pediatric migraine risk after adjusting for covariates.

CONCLUSION

5-HT, PTX-3, and inflammatory markers are promising biomarkers for PFO-related pediatric migraine. A multi-marker approach significantly enhances risk prediction, supporting its potential for clinical stratification and targeted interventions.