Critical Care Management of Intracerebral Hemorrhage

Substance P (SP) is implicated in brain inflammation. We clarified relationship between serum SP concentrations and functional outcome of acute intracerebral hemorrhage (ICH).

We quantified admission serum SP concentrations in 106 ICH patients. The primary outcome measure was a poor outcome at 90 days (modified Rankin Scale score ≥ 3) after onset.

Patients with a poor outcome compared with the rest had substantially higher serum SP concentrations. The area under the curve for serum SP concentrations with regard to discriminating a poor outcome was 0.795 (95% CI, 0.706 to 0.867). Serum SP concentrations >449 pg/ml predicted the risk of a poor outcome with 63.0% sensitivity and 78.9% specificity, and were independently associated with a poor outcome (odds ratio, 5.437; 95% CI, 2.156 to 13.715). There were the positive associations between serum SP concentrations, National Institutes of Health Stroke Scale score (r = 0.480), hematoma volume (r = 0.464) and serum C-reactive protein concentrations (r = 0.398).

Higher serum SP concentrations in the acute phase of ICH were intimately associated with aggravated inflammation response, rising severity and increased risk of a poor functional outcome, suggesting that serum SP could be an inflammatory prognostic factor for ICH.

Netrin-1 is an axon guidance protein, which can inhibit inflammatory reaction and stabilize the blood-brain barrier to protect against experimental brain injury. We evaluated the concentration of netrin-1 in acute intracerebral hemorrhage (ICH) patients and explored whether netrin-1 is a potential prognostic biomarker for ICH.

This study recruited a total of 126 ICH patients and 126 healthy controls. Netrin-1 concentration was determined using a commercially available human enzyme-linked immune sorbent assay kit. National Institutes of Health Stroke Scale (NIHSS) score and hematoma volume were used to assess hemorrhagic severity. An unfavorable outcome was defined as modified Rankin Scale >2 at 90 days.

ICH patients showed significantly lower serum netrin-1 concentrations than controls. Serum netrin-1 concentrations were strongly and inversely correlated with serum C-reactive protein concentrations, NIHSS score and hematoma volume. Multivariate analyses revealed that low netrin-1 concentration was associated with 90-day death, unfavorable outcome and overall survival after adjustment for other confounding variables. Under the receiver operating characteristic curve, serum netrin-1 remarkably discriminated patients at risk of 90-day death and unfavorable outcome.

Serum netrin-1 concentrations are decreased in patients with ICH, and the concentrations of netrin-1 were intimately associated with inflammation, hemorrhagic severity and clinical outcome of ICH.

Reduced serum omentin-1 concentrations might be related to an increased risk for poor functional outcome after acute ischemic stroke. We intended to explore whether serum omentin-1 could be a promising prognostic biomarker for acute intracerebral hemorrhage.

A total of 104 consecutive patients with hemorrhagic stroke underwent 90-day follow-up. The modified Rankin scale score >2 was evaluated as worse prognosis. A multivariable logistic model was conFig.d for assessing the relationship between serum omentin-1 concentrations and functional outcome.

Serum omentin-1 concentrations, with the median value of 147.9 ng/ml (interquartile range, 114.7–199.8 ng/ml), were substantially declined with rising modified Rankin scale scores (P < 0.001). Serum omentin-1 concentrations <147.9 ng/ml was independently related to higher risk of 90-day worse prognosis (odds ratio, 3.789; 95% confidence interval, 1.819–8.608; P = 0.018). Under receiver operating characteristic curve, an optimal value of serum omentin-1 concentrations was selected as 179.7 ng/ml, which yielded 0.88 sensitivity value and 0.70 specificity value for discriminating patients at risk of 90-day worse prognosis (area under curve, 0.82; 95% confidence interval, 0.73–0.89).

Lower serum omentin-1 concentrations are closely associated with poor functional outcome after hemorrhagic stroke, substantializing serum omentin-1 as a potential prognostic biomarker for acute intracerebral hemorrhage.

Osteopontin (OPN), a matricellular protein, is greatly generated from brain tissues after acute brain injury. We determine the relationship between plasma OPN concentrations and outcome after acute intracerebral hemorrhage (ICH) in a clinical setting.

In this prospective, observational study enrolling 162 ICH patients and 162 healthy controls, hemorrhagic severity was assessed using National Institutes of Health Stroke Scale (NIHSS) scores and hematoma volumes, a poor outcome was defined as modified Rankin Scale >2 at poststroke 90 days, and early neurologic deterioration (END) was defined as an increase of ≥4 points in the NIHSS score or death at 24 h from symptoms onset.

Plasma OPN concentrations were significantly higher in patients than in controls (median value, 1287.6 vs. 405.7 pmol/l; P < 0.001). OPN concentrations were strongly correlated with admission NIHSS scores (r value = 0.520) and hematoma volumes (r value = 0.468). Areas under receiver operating characteristic curve for poor outcome and END were 0.811 and 0.753 respectively. Plasma OPN emerged as an independent predictor of functional outcome and END, with odds ratio values of 3.897 and 6.004 respectively.

Plasma OPN could serve as a useful prognostic biomarker in ICH.

Klotho is an anti-aging protein and its increased plasma concentrations were related to good functional outcome of acute ischemic stroke. This study was designed to ascertain the prognostic significance of plasma Klotho in intracerebral hemorrhage.

Plasma Klotho concentrations in 96 intracerebral hemorrhage patients and 96 healthy controls were quantified. Poor prognosis was defined as modified Rankin scale scores >2 at 90 days. The association of plasma Klotho concentrations with stroke prognosis was assessed using regression model.

Patients showed a substantially lower concentration of Klotho than healthy controls (P < .01). Klotho concentrations were highly correlated with National Institutes of Health Stroke Scale scores, Glasgow coma scale scores, intracerebral hemorrhage scores and hematoma volumes (r = −0.426, 0.382, −0.334 and − 0.432). Patients with the highest plasma Klotho concentration were less prone to have poor prognosis at 90 days compared with the lowest quartile (odds ratio, 0.092; 95% confidence interval, 0.015–0.562). Its optimal cutoff value for distinguishing patients at risk of poor prognosis was 345 pg/ml, which yielded a sensitivity value of 0.86 and a specificity value of 0.62.

Decreased plasma Klotho concentrations were associated with increasing severity and poor prognosis significantly, indicating the prognostic role of plasma Klotho in intracerebral hemorrhage.

Lipoprotein-associated phospholipase A2 (Lp-PLA2) is reflective of vascular inflammation and plays a role in the pathophysiology of cerebrovascular disease. We determine usefulness of serum Lp-PLA2 as a prognostic biomarker for intracerebral hemorrhage (ICH).

In this prospective, observational study, serum Lp-PLA2 concentrations were detected among 164 patients with acute spontaneous basal ganglia hemorrhage and 164 healthy controls. Using multivariate analysis, we analyzed its association with poor outcome (modified Rankin Scale >2) at poststroke 90 days and hemorrhagic severity indicated by National Institutes of Health Stroke Scale (NIHSS) score and hematoma volume.

Serum Lp-PLA2 concentrations were remarkably higher in patients than in controls. Lp-PLA2 concentrations were independently correlated with NIHSS score (t = 5.095, P < .001) and hematoma volume (t = 2.850, P = .005). At 90-day follow-up, 85 patients (51.8%) had poor outcome. Under receiver operating characteristic curve, serum Lp-PLA2 showed a significant prognostic discriminatory capability (AUC, 0.813; 95% CI, 0.744–0.869). Serum Lp-PLA2 concentrations ≥304 ng/ml was an independent predictor associated with poor outcome (OR 7.052; 95% CI 1.971–25.228).

Rising serum Lp-PLA2 concentrations are closely hemorrhagic severity and clinical outcomes after ICH, substantializing serum Lp-PLA2 as a potential prognostic biomarker of ICH.