Combatting Secondary Injury From Intracerebral Hemorrhage With Supplemental Antioxidant Therapy

Shoamanesh, Ashkan; Katsanos, Aristeidis H.

doi:10.1161/strokeaha.121.033849

Stroke

2021

DOI: 10.1161/strokeaha.121.033849

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Combatting Secondary Injury From Intracerebral Hemorrhage With Supplemental Antioxidant Therapy

Ashkan Shoamanesh

Aristeidis H. Katsanos

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Cited by 5 publications

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“…1–3 The hyperacute phase of ICH encompasses primary injury caused by the hematoma and its expansion, and secondary injury that results from the activation of inflammation and coagulation cascades. 4–7 The pathophysiologic hallmark of early brain inflammation after ICH is neutrophil extravasation, which occurs within 4 to 5 hours of ICH onset and peaks at 3 days. 8 Neutrophils damage the brain by producing reactive oxygen species, releasing proinflammatory proteases, affecting blood–brain barrier permeability, and promoting neuronal death.…”

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Association Between Soluble Intercellular Adhesion Molecule-1 and Intracerebral Hemorrhage Outcomes in the FAST Trial

Witsch

Roh

et al. 2023

Stroke

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BACKGROUND: Neutrophil-mediated inflammation in the acute phase of intracerebral hemorrhage (ICH) worsens outcome in preclinical studies. sICAM-1 (soluble intercellular adhesion molecule-1), an inducible ligand for integrins and cell-cell adhesion molecules, is critical for neutrophil extravasation. We aimed to determine whether serum levels of sICAM-1 are associated with worse outcomes after ICH. METHODS: We conducted a post hoc secondary analysis of an observational cohort using data from the FAST trial (Factor-VII for Acute Hemorrhagic Stroke Treatment). The study exposure was the admission serum level of sICAM-1. The coprimary outcomes were mortality and poor outcome (modified Rankin Scale score 4–6) at 90 days. Secondary radiological outcomes were hematoma expansion at 24 hours and perihematomal edema expansion at 72 hours. We used multiple linear and logistic regression analyses to test for associations between sICAM-1 and outcomes, after adjustment for demographics, ICH severity characteristics, change in the systolic blood pressure in the first 24 hours, treatment randomization arm, and the time from symptom onset to study drug administration. RESULTS: Of 841 patients, we included 507 (60%) with complete data. Hematoma expansion occurred in 169 (33%), while 242 (48%) had a poor outcome. In multivariable analyses, sICAM-1 was associated with mortality (odds ratio, 1.53 per SD increase [95% CI, 1.15–2.03]) and poor outcome (odds ratio, 1.34 per SD increase [CI, 1.06–1.69]). In multivariable analyses of secondary outcomes, sICAM-1 was associated with hematoma expansion (odds ratio, 1.35 per SD increase [CI, 1.11–1.66]), but was not associated with log-transformed perihematomal edema expansion at 72 hours. In additional analyses stratified by treatment assignment, similar results were noted in the recombinant activated factor-VII arm, but not in the placebo arm. CONCLUSIONS: Admission serum levels of sICAM-1 were associated with mortality, poor outcome, and hematoma expansion. Given the possibility of a biological interaction between recombinant activated factor-VII and sICAM-1, these findings highlight the need to further explore the role of sICAM-1 as a potential marker of poor ICH outcomes.

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confidence: 99%

Association Between Soluble Intercellular Adhesion Molecule-1 and Intracerebral Hemorrhage Outcomes in the FAST Trial

Witsch

Roh

et al. 2023

Stroke

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Perihematomal Edema and Clinical Outcome After Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis

et al. 2022

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Improving outcomes in intracerebral hemorrhage through microglia/macrophage-targeted IL-10 delivery with phosphatidylserine liposomes

et al. 2023

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Combatting Secondary Injury From Intracerebral Hemorrhage With Supplemental Antioxidant Therapy

Cited by 5 publications

References 12 publications

Association Between Soluble Intercellular Adhesion Molecule-1 and Intracerebral Hemorrhage Outcomes in the FAST Trial

Association Between Soluble Intercellular Adhesion Molecule-1 and Intracerebral Hemorrhage Outcomes in the FAST Trial

Perihematomal Edema and Clinical Outcome After Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis

Improving outcomes in intracerebral hemorrhage through microglia/macrophage-targeted IL-10 delivery with phosphatidylserine liposomes

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