PMID- 30613458
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220410
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 10
IP  - 10
DP  - 2018 Oct 31
TI  - Inflammatory Markers and Severity of Intracerebral Hemorrhage.
PG  - e3529
LID - 10.7759/cureus.3529 [doi]
LID - e3529
AB  - Background and purpose The 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). Methods We 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. Results Forty-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. Conclusion After 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.
FAU - Bernstein, Jacob E
AU  - Bernstein JE
AD  - Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, 
      USA.
FAU - Savla, Paras
AU  - Savla P
AD  - Osteopathy, College of Osteopathic Medicine - Touro University, Vallejo, USA.
FAU - Dong, Fanglong
AU  - Dong F
AD  - Clinical Research, Western University of Health Sciences, Pomona, USA.
FAU - Zampella, Bailey
AU  - Zampella B
AD  - Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, 
      USA.
FAU - Wiginton, James G 4th
AU  - Wiginton JG 4th
AD  - Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, 
      USA.
FAU - Miulli, Dan E
AU  - Miulli DE
AD  - Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, 
      USA.
FAU - Wacker, Margaret R
AU  - Wacker MR
AD  - Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, 
      USA.
FAU - Menoni, Rosalinda
AU  - Menoni R
AD  - Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, 
      USA.
LA  - eng
PT  - Journal Article
DEP - 20181031
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC6314395
OTO - NOTNLM
OT  - c-reactive protein (crp)
OT  - homocysteine (hcy)
OT  - intracerebral hemorrhage (ich)
OT  - tumor necrosis factor alpha (tnf alpha)
OT  - vascular endothelial growth factor (vegf)
COIS- The authors have declared that no competing interests exist.
EDAT- 2019/01/08 06:00
MHDA- 2019/01/08 06:01
PMCR- 2018/10/31
CRDT- 2019/01/08 06:00
PHST- 2019/01/08 06:00 [entrez]
PHST- 2019/01/08 06:00 [pubmed]
PHST- 2019/01/08 06:01 [medline]
PHST- 2018/10/31 00:00 [pmc-release]
AID - 10.7759/cureus.3529 [doi]
PST - epublish
SO  - Cureus. 2018 Oct 31;10(10):e3529. doi: 10.7759/cureus.3529.