Early Serum Biomarkers for Intensive Care Unit Treatment within the First 24 Hours in Patients with Intracerebral Hemorrhage

Abstract

Background The prognostic significance of serum biomarkers in patients with intracerebral hemorrhage (ICH) is not well investigated concerning inhospital mortality (IHM) and cardiopulmonary events within the first 24 hours of intensive care unit (ICU) treatment. The influence of troponin I (TNI) value and cortisol value (CV) on cardiopulmonary events within the first 24 hours of ICU treatment was reported in subarachnoid hemorrhage patients, but not in ICH patients up to now. The aim of this study was to investigate the role of early serum biomarkers on IHM and TNI value and CV on cardiopulmonary events within the first 24 hours of ICU treatment. Patients and Methods A total of 329 patients with spontaneous ICH were retrospectively analyzed. Blood samples were taken on admission to measure serum biomarkers. The TNI value and CV were defined as biomarkers for cardiopulmonary stress. Demographic data, cardiopulmonary parameters, including norepinephrine application rate (NAR) in microgram per kilogram per minute and inspiratory oxygen fraction (FiO2) within the first 24 hours, and treatment regime were analyzed concerning their impact on ICU treatment and in hospital outcome. Binary logistic analysis was used to identify independent prognostic factors for IHM. Results Patients with initially nonelevated CVs required higher NAR (p = 0.01) and FiO2 (p = 0.046) within the first 24 hours of ICU treatment. Lower cholinesterase level (p = 0.004), higher NAR (p = 0.002), advanced age (p < 0.0001), larger ICH volume (p < 0.0001), presence of intraventricular hemorrhage (p = 0.007) and hydrocephalus (p = 0.009), raised level of C-reactive protein (p = 0.024), serum lactate (p = 0.003), and blood glucose (p = 0.05) on admission were significantly associated with IHM. In a multivariate model, age (odds ratio [OR]: 1.055; 95% confidence interval [CI]: 1.026–1.085; p < 0.0001), ICH volume (OR: 1.016; CI: 1.008–1.025; p < 0.0001), and Glasgow Coma Scale (GCS) score (OR: 0.680; CI: 0.605–0.764; p < 0.0001) on admission as well as requiring NAR (OR: 1.171; CI: 1.026–1.337; p = 0.02) and FiO2 (OR: 0.951; CI: 0.921–0.983, p = 0.003) within the first 24 hours were independent predictors of IHM. Conclusion Higher levels of C-reactive protein, serum lactate, blood glucose, and lower cholinesterase level on admission were significantly associated with IHM. Patients with initially nonelevated CVs required higher NAR and FiO2 within the first 24 hours of ICU treatment. Furthermore, requiring an NAR > 0.5 µg/kg/min or an FiO2 > 0.21 were identified as additional independent predictors for IHM. These results could be helpful to improve ICU treatment in ICH patients.

Association Between Oxygen Partial Pressure Trajectories and Short-Term Outcomes in Patients With Hemorrhagic Brain Injury

“…We identified several factors associated with prognosis in the multivariable logistic regression analysis, including age > 65 years, intubation, hypertension, diabetes, apnea, SOFA score, glucose level, WBC count, and GCS on admission. These results are in line with previous findings that age ( 34 ), intubation ( 35 ), GCS on admission, severity of illness ( 4 ), hypertension, diabetes ( 36 ), apnea, high blood glucose levels ( 6 ), and WBC count ( 37 ) are significant predictors of the outcomes in patients with various HBI.…”

“…Despite improvements in management, HBI still accounts for the death of ~10 million people every year and causes long-term disabilities ( 2 , 3 ). Many risk factors for poor outcome of various type of HBI have been identified, such as glasgow coma scale (GCS) on admission, severity of illness ( 4 ), low calcium ( 4 ) and hemoglobin levels ( 5 ), high serum lactate and blood glucose levels, and a low cholinesterase level ( 6 ). Impaired oxygenation is common among patients with HBI ( 7 , 8 ), and multiple studies have shown that prehospital hypoxia ( 9 ) or hypoxic episodes during intensive care ( 10 ) are associated with poor prognosis in patients with traumatic brain injury (TBI).…”

Association of early glycemic change with short-term mortality in lobar and non-lobar intracerebral hemorrhage

“…Our findings agree with previous evidence that admission RSG is an independent predictor of short-term ICH mortality 7 – 14 . The association was not confirmed in two cohorts including a large proportion of patients with very severe ICH 34 , 35 . However, in very severe ICH, major predictors of short-term mortality such as clinical and neuroradiological features are known to obscure the role of weaker predictors such as admission hyperglycemia 11 .…”

Serum Lactate as Serum Biomarker for Cardiopulmonary Parameters within the First 24 Hours after a Spontaneous Intracerebral Hemorrhage

“…A spontaneous intracerebral hemorrhage (ICH) is still associated with a high rate of morbidity and mortality, and only a fifth of all patients recover to live an independent life [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 ]. In particular, the neurological deterioration occurs in up to 30% of ICH patients within the first 24 h due to the expansion of the ICH [ 6 , 7 , 8 ]. Therefore, this period of ICU treatment is important concerning patients’ outcomes [ 8 ].…”

“…However, CP complications, including electrocardiographic and cardiac wall motion abnormalities, as well as pulmonary alterations, are often seen in ICH patients [ 9 , 10 , 11 , 12 , 13 ]. The pathophysiological pathway of these complications could be justified by a neurogenic triggered autonomic dysregulation with an excessive catecholamine response to the circulation [ 1 , 2 , 6 , 10 ]. Nevertheless, the exact mechanism remains unclear.…”