Department of Neurology, Neurosciences Centre, All India Institute of Medical Sciences, Room No. 02, 6th Floor, Ansari Nagar, New Delhi, India.
Department of Biochemistry, All India Institute of Medical Sciences, Rishikesh, India.
J Stroke Cerebrovasc Dis. 2021 Mar;30(3):105537. doi: 10.1016/j.jstrokecerebrovasdis.2020.105537. Epub 2020 Dec 15.
Intracerebral hemorrhage (ICH) is associated with high mortality, morbidity, and recurrence. Studies have reported the accuracy of several blood biomarkers in predicting clinical outcomes; however, their independent contribution in prediction remains to be established.
To investigate the incremental accuracy in predicting clinical outcomes in patients with ICH in a north Indian population using blood-based biomarkers.
In this study, a total of 250 ICH cases were recruited within 72 hours of onset. Baseline clinical and CT scan measurement were recorded. Homocysteine (HCY), C-reactive protein (CRP), matrix metalloproteinase-9 (MMP9), E-selectin (SELE), and P-selectin (SELP) levels were measured through ELISA. Telephonic follow-up was done by using mRS scale at three months.
The mean age of cohort was 54.9 (SD±12.8) years with 64.8% patients being male. A total of 109 (43.6%) deaths were observed over three months follow-up. Area under the receiver operating characteristics curve-(AUROC) for 90-day mortality were 0.55 (HCY), 0.62 (CRP), 0.57 (MMP9), 0.60 (SELE) and 0.53 (SELP) and for poor outcome at 90-day (mRS: 3-6) were 0.60 (HCY), 0.62 (CRP), 0.54 (MMP9), 0.67 (SELE) and 0.54 (SELP). In multivariable model including age, ICH volume, IVH and GCS at admission, serum SELE (p=0.004) significant for poor outcome with improved AUROC (0.86) and HCY (p=0.04), CRP (p=0.003) & MMP9 (p=0.02) for mortality with least Akaike's Information Criterion-(AIC) (1060.5).
Our findings suggest that the serum SELE is a significant predictor of poor outcome and HCY, CRP & MMP9 for Mortality in patients with ICH in the north Indian population.
脑出血（ICH）与高死亡率、高发病率和高复发率相关。已有研究报道了多种血液生物标志物在预测临床结局方面的准确性，但它们在预测中的独立贡献仍有待确定。
使用基于血液的生物标志物，在印度北部人群中，研究脑出血患者的临床结局的预测准确性。
本研究共纳入 250 例 ICH 发病后 72 小时内的患者。记录基线临床和 CT 扫描测量值。通过 ELISA 测量同型半胱氨酸（HCY）、C 反应蛋白（CRP）、基质金属蛋白酶-9（MMP9）、E-选择素（SELE）和 P-选择素（SELP）水平。通过 mRS 量表在三个月时进行电话随访。
队列的平均年龄为 54.9（SD±12.8）岁，64.8%的患者为男性。在三个月的随访中，共有 109 例（43.6%）死亡。90 天死亡率的受试者工作特征曲线下面积（AUROC）分别为 0.55（HCY）、0.62（CRP）、0.57（MMP9）、0.60（SELE）和 0.53（SELP），90 天不良结局（mRS：3-6）的 AUROC 分别为 0.60（HCY）、0.62（CRP）、0.54（MMP9）、0.67（SELE）和 0.54（SELP）。在包括年龄、ICH 体积、IVH 和入院时 GCS 在内的多变量模型中，血清 SELE（p=0.004）与不良结局显著相关，AUROC 改善（0.86），HCY（p=0.04）、CRP（p=0.003）和 MMP9（p=0.02）与死亡率相关，最小 Akaike 信息准则（AIC）（1060.5）。
我们的研究结果表明，在印度北部人群中，血清 SELE 是脑出血患者不良结局的重要预测指标，而 HCY、CRP 和 MMP9 则是死亡率的预测指标。
