PMID- 33585095
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20210216
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 13
IP  - 1
DP  - 2021 Jan 10
TI  - Inflammatory Markers in Severity of Intracerebral Hemorrhage II: A Follow Up 
      Study.
PG  - e12605
LID - 10.7759/cureus.12605 [doi]
LID - e12605
AB  - Introduction Spontaneous intracerebral hemorrhage (ICH) results in significant 
      morbidity and mortality. The pathogenesis of brain injury after ICH is thought to 
      be due to mechanical damage followed by ischemic, cytotoxic, and inflammatory 
      changes in the underlying and surrounding tissue. Various inflammatory and 
      non-inflammatory biomarkers have been studied as predictors and potential 
      therapeutic targets for intracerebral hemorrhage. Our prior study showed an 
      association with low vascular endothelial growth factor (VEGF) levels and 
      increased mortality. This current study looks to expand on our prior results and 
      will look at the relationship between tumor necrosis factor alpha (TNFalpha), 
      C-reactive protein (CRP), VEGF, Homocysteine (Hcy), and CRP to albumin ratio 
      (CAR) in predicting outcomes and severity in spontaneous intracerebral 
      hemorrhage. Methods We conducted a retrospective chart review of patients with 
      spontaneous intracerebral hemorrhage with TNFalpha, CRP, VEGF, Hcy levels drawn on 
      admission. Albumin and CRP levels on admission were used to calculate CAR. 
      Ninety-nine patients were included in the study. Primary outcomes included death, 
      early neurologic decline (END), and hemorrhage size. Secondary outcomes included 
      late neurologic decline (LND), Glasgow Coma Scale (GCS) on admission, GCS on 
      discharge, ICH score, change in hemorrhage size, need for surgical intervention, 
      and length of ICU stay. Results A total of 99 patients were included in this 
      study, with 42% requiring surgical intervention and an overall mortality of 16%. 
      Basal ganglia hemorrhage was seen in 41% of patients. Hcy and CAR were 
      significantly correlated with ICH size in basal ganglia patients (r-=0.36, 
      p=0.03; r=0.43, p=0.03, respectively). CAR was significantly correlated with ICH 
      score (r=0.33, p=0.007874). Admission VEGF levels less than 45 pg/ml had 8.4-fold 
      increase in mortality (odds ratio [OR] 8.4545, p=0.0488). Patients with TNFalpha 
      levels greater than 1.40 pg/ml had a 4.1-fold increase in mortality (OR 4.1, 
      p=0.04) Conclusion Our study demonstrated that low levels (<45 pg/ml) of VEGF 
      were associated with an 8.4-fold increase in mortality, supporting the 
      neuroprotective effect of this protein. Elevated Hcy and CAR levels were 
      associated with an increase in hemorrhage size in patients with basal ganglia 
      hemorrhages. TNFalpha levels greater than 1.40 pg/ml were associated with a 4.1-fold 
      increase in mortality, and this together with CAR being correlated with increased 
      hemorrhage size and ICH score further demonstrate the inflammatory consequences 
      after intracerebral hemorrhage. Future studies directed at lowering CRP, TNFalpha, 
      and Hcy and/or increasing VEGF in intracerebral hemorrhage patients are needed 
      and may be beneficial.
CI  - Copyright (c) 2021, Bernstein et al.
FAU - Bernstein, Jacob E
AU  - Bernstein JE
AD  - Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, 
      USA.
FAU - Browne, Jonathan D
AU  - Browne JD
AD  - School of Medicine, California University of Science and Medicine, Colton, USA.
FAU - Savla, Paras
AU  - Savla P
AD  - Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, 
      USA.
FAU - Wiginton, James 4th
AU  - Wiginton J 4th
AD  - Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, 
      USA.
FAU - Patchana, Tye
AU  - Patchana T
AD  - Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, 
      USA.
FAU - Miulli, Dan E
AU  - Miulli DE
AD  - Neurosurgery, Arrowhead Regional Medical Center, Colton, USA.
FAU - Wacker, Margaret Rose
AU  - Wacker MR
AD  - Neurosurgery, Arrowhead Regional Medical Center, Colton, USA.
FAU - Duong, Jason
AU  - Duong J
AD  - Neurosurgery, Arrowhead Regional Medical Center, Colton, USA.
LA  - eng
PT  - Journal Article
DEP - 20210110
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC7872478
OTO - NOTNLM
OT  - c-reactive protein
OT  - homocysteine
OT  - intracerebral hemorrhage
OT  - tnf alpha
OT  - vegf angiogenesis
COIS- The authors have declared that no competing interests exist.
EDAT- 2021/02/16 06:00
MHDA- 2021/02/16 06:01
PMCR- 2021/01/10
CRDT- 2021/02/15 06:10
PHST- 2021/02/15 06:10 [entrez]
PHST- 2021/02/16 06:00 [pubmed]
PHST- 2021/02/16 06:01 [medline]
PHST- 2021/01/10 00:00 [pmc-release]
AID - 10.7759/cureus.12605 [doi]
PST - epublish
SO  - Cureus. 2021 Jan 10;13(1):e12605. doi: 10.7759/cureus.12605.