Can brain natriuretic peptide, S100b, and interleukin-6 prognosticate the neurological consequences in Egyptian patients presented with supratentorial intracerebral hemorrhage?

Abstract

Background: Biomarkers in supratentorial intracerebral hemorrhage (SICH) enhance the prognosis of the disease. This study aimed to assess the prognosticative grade of S100 calcium-binding protein B (S100B), interleukin-6 (IL-6), and the pro-brain natriuretic peptide (pro-BNP) in SICH outcome prediction. Methods: Blood samples of 50 SICH patients were analyzed for the biomarkers. The patients were classified into two groups with and without intraventricular hemorrhage (IVH). The following scales including Glasgow Coma Score (GCS), the Barthel index (BI), intracerebral hemorrhage (ICH) score, ICH volume, National Institutes of Health Stroke Scale (NIHSS), Modified Rankin Score (mRS), and length of stay were used to evaluate the severity. Results: The severity scores (NIHSS, GCS, BI, mRI) were significantly higher in SICH patients with IVH versus SICH patients without IVH (P = 0.002, 0.008, 0.001, and 0.03, respectively). Serum levels for a pro-BNP and S100b are significantly higher in SICH patients with IVH versus SICH patients without IVH (P = 0.02 and 0.027, respectively). Multivariate correlations between demographic (age), biomarkers panel (IL-6, S100b, and proBNP), and clinical and severity scores (ICH score, ICH volume, length of hospital stay [LOS], BI, mRS, GCS, and NIHSSS) in all studied patients showed a highly significant correlation between ICH score and pro-BNP (P = 0.04). There was a highly significant correlation between LOS and IL-6 (P = 0.003). Conclusion: Pro-BNP, IL-6, and S100b are greatly associated with the presence of IVH that, in turn, correlated well with poor clinical outcome measures.

Association of Natriuretic Peptide With Adverse Outcomes and Disease Severity After Intracerebral Hemorrhage: A Systematic Review

“…After eliminating duplications, 1,125 articles were retained, of which 1,097 were excluded due to irrelevant titles and abstracts. The full texts of the remaining 28 articles were reviewed for inclusion, and 10 studies (18)(19)(20)(25)(26)(27)(28)(29)(30)(31) fulfilled the inclusion criteria for systematic review. The detailed process of study screening is shown in Figure 1.…”

“…Moreover, the predictive value was independent of previously recognized prognostic factors such as age, hematoma volume, and baseline neurological impairment. However, in terms of functional outcome, one (31) of the five included studies did not report the correlation between serum NT-proBNP level and poor functional outcome. This omission might be due to the high heterogeneous of the included patients (initial neurological function and hematoma size), limited sample size (50 cases) or short follow-up time (hospital discharge).…”

“…Their results revealed that in patients with severe ICH (GCS scores of ≤8), serum NT-proBNP level was positively associated with intracranial pressure (r = 0.703), but negatively with blood sodium concentration (r = −0.704), which did not occur in mild-moderate patients. Further studies demonstrated associations between BNP/NT-proBNP levels and intraventricular hemorrhage (20,31), ventricular dilatation and hydrocephalus (26).…”

“…As shown in Table 3, seven studies (20,25,26,(28)(29)(30)(31) mentioned the relationship between BNP/NT-proBNP levels and disease severity in ICH patients. In these studies, the most commonly used marker to reflect disease severity was ICH volume (7 studies, 100%), assessed by CT scans on admission.…”

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“…Five studies (20,26,(28)(29)(30) showed that BNP/NT-proBNP level was positively correlated with ICH volume. However, James et al (25) and Eldawoody et al (31) suggested a nonsignificant association between BNP/NT-proBNP levels and hematoma volume, although both indicated the relationship between BNP/NT-proBNP and ICH score. Three studies (28)(29)(30) divided patients into massive (>30 ml) and small-moderate (<30 ml) hemorrhage groups based on hematoma volume [Yang et al (29) used 20 ml as a cutoff value], indicating higher levels of NT-proBNP in the former (range of means: 801.7-2116.3 vs. 165.5-493.7 pg/ml; P < 0.05).…”