Inflammatory Markers and Severity of Intracerebral Hemorrhage

Abstract

Background and purposeThe pathogenesis of brain injury after intracerebral hemorrhage is thought to be due to mechanical damage followed by ischemic, cytotoxic, and inflammatory changes in the underlying and surrounding tissue.In recent years, there has been a greater research interest into the various inflammatory biomarkers and growth factors that are secreted during intracerebral hemorrhage. The biomarkers investigated in this study are tumor necrosis factor alpha (TNF alpha), C-reactive protein (CRP), homocysteine (Hcy), and vascular endothelial growth factor (VEGF). The aim of this study was to further investigate the effects of these biomarkers in predicting the acute severity outcome of intracerebral hemorrhage (ICH).MethodsWe conducted a retrospective chart review of patients with spontaneous ICH with TNF alpha, CRP, VEGF, and Hcy levels drawn on admission. Forty-two patients with spontaneous ICH with at least one of the above labs were included in the study. Primary outcomes included death, Glasgow Coma Scale (GCS) on admission, early neurologic decline (END), and hemorrhage size. Secondary outcomes included GCS on discharge, ICH score, functional outcome risk stratification scale of intracerebral hemorrhage (FUNC score), change in hemorrhage size, need for surgical intervention, and length of intensive care unit (ICU) stay.ResultsForty-two patients with spontaneous intracerebral hemorrhage (ICH) were analyzed, 12 patients (28.5%) required surgical intervention, and four patients (9.5%) died. Only low VEGF serum values were found to predict mortality. TNF alpha, CRP, Hcy, and VEGF levels in our patients with ICH were not found to predict early neurologic decline and were not correlated with GCS on admission, initial hemorrhage size, change in hemorrhage size, need for surgical intervention, ICH score, FUNC score, midline shift, and length of ICU stay. CRP and Hcy were elevated in 58% and 31% of patients tested, respectively. GCS on admission and ICH score were significantly associated with mortality.ConclusionAfter careful statistical review of the data obtained from this patient population, only low VEGF values were found to be a significant predictor of mortality. However, elevated CRP and Hcy levels were associated with a non-significant trend in hemorrhage size and mortality suggesting that CRP and Hcy-lowering therapies may decrease hemorrhagic stroke risk and severity.

Interaction of Microglia and Astrocytes in the Neurovascular Unit

“…In stroke, the inflammatory factors secreted by activated microglia (M1), such as TNF-α, IL-1β, and IL-6, are significantly elevated (77,78,127). Furthermore, a recent clinical inflammatory factor test is about the relationship of inflammatory markers and severity of ICH, and this test displayed that high TNF-a is closely associated with the size of edema around the hematoma and increase of early hematoma, leading to poor functional recovery and high mortality (128). These studies imply the different types and severities of insults release different combinations or levels of these molecule signals, which in turn trigger different responses.…”

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

“…A variety of additional biomarkers, for example, serum melatonin level, the neutrophil-to-lymphocyte ratio, vascular endothelial growth factor level, serum tau level, and S100A12 level are described with regard to their impact on outcome and IHM after ICH; however, determination of these markers is elaborate and was not part of this study. [46][47][48][49][50] With regard to cardiopulmonary parameters, higher average NAR within the first 24 hours of ICU treatment was associated with IHM. In a multivariate analysis, requirement of NAR and FiO 2 within the first 24 hours of ICU treatment was identified as additional independent predictors for IHM in this cohort.…”

Associations Between Levels of High-Sensitivity C-Reactive Protein and Outcome After Intracerebral Hemorrhage

“…All of these poor outcomes may arise from the acute inflammatory response that can occur several minutes after ICH and then trigger systemic inflammation ( 11 , 23 ). hs-CRP is an established laboratory marker for inflammation and poor clinical outcomes after ICH ( 24 ). However, whether hs-CRP is related to spot signs or HE has not been ascertained in previous research.…”