Feasibility of a pilot study on point-of-care biomarkers in spontaneous intracerebral hemorrhage in an emergency setting

Abstract

Background and aims. Stroke is a worldwide leading cause of death and disability and spontaneous intracerebral hemorrhage (sICH) has significant economic and social impact, regardless of recent efforts towards outcome-bettering acute interventions. The aim of the study was to assess the feasibility of a prospective observational research regarding point-of-care (POC) biomarkers in sICH, conducted in a level one emergency department (ED).
 Methods. Patients with acute (<8 hours) sICH were enrolled in this study. Patients presenting a Glasgow Coma Scale score <8, secondary causes of intracerebral hemorrhage, seizures, recent ischemic events, known thromboembolic disease, anticoagulant treatment, severe pre-stroke disability, terminal disease, scheduled neurosurgery/ hemostatic treatment were excluded. Feasibility was defined as ED inclusion and follow-up rates, time-to-inclusion, and frequency of missing data. Baseline demographic, imaging and POC biochemical status of the study group were documented, including inflammatory (complete blood count, C-reactive protein), metabolic (glucose, hepatic, and renal function) and cardiovascular markers (cardiac troponin I, D-dimer).
 Results. The inclusion rate was 2.16 patients/month with a final sample of 35 patients out of 239 potentially eligible patients. The median time from symptom onset to ED presentation was 128 minutes (IQR 96-239), with 21/35 patients having presented within the first 3 hours from ictus. Median times between symptoms’ onset to Computer Tomography (CT) scan and ED presentation to CT scan were 170 minutes (IQR 126-317) and 25 minutes (IQR 17-62), respectively. The median time from patient’s presentation to CBC result was 12 minutes (IQR 6.5-20), with 21/35 study participants having the results available within 15 minutes from ED arrival. The median cohort age was 72-years, with a 19/16 male/female ratio. Hypertension was the most frequent risk factor (77%), along with ischemic heart disease (31%) and diabetes (29%). One-third of the hypertensive patients did not undergo blood pressure lowering treatment. Median values of POC biomarkers on ED admission were within normal range. 
 Conclusions. It was feasible to determine point-of-care biomarkers in spontaneous intracerebral hemorrhage on admission in ED, despite the urgency of the medical condition.

Emergency department point‑of‑care biomarkers and day 90 functional outcome in spontaneous intracerebral hemorrhage: A single‑center pilot study

“…The contribution of EOS to sICH prognostication is not completely understood; however, Chen et al ( 14 ) correlated EOS count with increased risk of HE. Moreover, the short interval from symptom onset to CBC sampling in the present cohort ( 39 ) might have prevented the documentation of the activation of local and systemic inflammation ( 13 , 22 , 48 ). In the present study, MID was documented as a surrogate for MON, but its values incorporate multiple cell populations.…”

“…In regard to Hb levels, lower mean admission values were recorded in the unfavorable outcome group, without statistical significance or without meeting the criteria of the definition of anemia ( 39 ). RDW is another inexpensive automatically generated hematology parameter that is impacted by inflammation ( 29 ), and our results indicated a modest correlation with admission PHE, but this was not associated with day 90 FO.…”

“…The design and enrolment processes of this prospective, single-center, ED-based pilot study have been previously published ( 39 ). To summarize, adult patients presenting with acute sICH (<8 h from onset) to the ED of the County Emergency Hospital (Cluj-Napoca, Romania) were recruited over 18 months (December 2017 to June 2018) provided that Glasgow Coma Scale (GCS) was ≥8 and no exclusion criteria were met.…”