Intensive Care Unit, Hospital Universitario de Canarias, Ofra s/n, La Laguna, Santa Cruz de Tenerife 38320, Spain.
Intensive Care Unit, Hospital Universitario Nuestra Señora de Candelaria, Crta del Rosario s/n, Santa Cruz de Tenerife 38010, Spain.
Anaesth Crit Care Pain Med. 2021 Dec;40(6):100969. doi: 10.1016/j.accpm.2021.100969. Epub 2021 Oct 27.
Apoptotic changes in brain samples have been found in haematoma areas of patients with spontaneous intracerebral haemorrhage (SIH) undergoing surgical haematoma evacuation. However, circulating caspase-8 concentrations in SIH patients have not been described. Thus, we carried out this study with the aim to explore whether there is an association of circulating caspase-8 concentrations and mortality in patients with SIH.
We included patients with severe and supratentorial SIH. We established that the SIH was severe if Glasgow Coma Scale (GCS) was lower than 9. Intensive Care Units from 5 Spanish hospitals carried out the recruitment of patients of this observational and prospective study. We registered serum caspase-8 levels at moment of severe SIH diagnosis and 30-day mortality.
Surviving (n = 41) in respect to non-surviving SIH patients (n = 38) showed lower serum caspase-8 levels (p < 0.001). The area under the curve to estimate 30-day mortality ability by serum caspase-8 levels was 0.75 (95% CI = 0.64-86; p < 0.001). Kaplan-Meier analysis found that patients with serum caspase-8 levels > 17.8 ng/mL showed higher death risk (Hazard ratio = 3.9; 95% CI = 1.99-7.63; p < 0.001). Multiple logistic regression analysis revealed the association of serum caspase-8 concentrations (controlling for intracerebral haemorrhage score, midline shift and early haematoma evacuation) with mortality at 30 days (Odds Ratio = 1.048; 95% CI = 1.018-1.079; p = 0.002).
The association of serum caspase-8 concentrations with mortality of SIH patient mortality is the main of novel findings that have been revealed in our study.
在接受自发性脑出血（ICH）手术血肿清除的患者的血肿区域中发现了脑样凋亡变化。然而，尚未描述 ICH 患者的循环胱天蛋白酶-8 浓度。因此，我们进行了这项研究，旨在探讨 ICH 患者循环胱天蛋白酶-8 浓度与死亡率之间是否存在关联。
我们纳入了患有严重和幕上 ICH 的患者。如果格拉斯哥昏迷量表（GCS）低于 9，则我们确定 ICH 严重。来自 5 家西班牙医院的重症监护病房进行了这项观察性和前瞻性研究的患者招募。我们在 ICH 严重诊断时和 30 天死亡率时记录了血清胱天蛋白酶-8 水平。
与非存活 ICH 患者（n=38）相比，存活患者（n=41）的血清胱天蛋白酶-8 水平较低（p<0.001）。通过血清胱天蛋白酶-8 水平估计 30 天死亡率的曲线下面积为 0.75（95%置信区间=0.64-86；p<0.001）。Kaplan-Meier 分析发现，血清胱天蛋白酶-8 水平>17.8ng/mL 的患者死亡风险更高（危险比=3.9；95%置信区间=1.99-7.63；p<0.001）。多变量逻辑回归分析显示，血清胱天蛋白酶-8 浓度（控制脑出血评分、中线移位和早期血肿清除）与 30 天死亡率相关（优势比=1.048；95%置信区间=1.018-1.079；p=0.002）。
我们的研究揭示了血清胱天蛋白酶-8 浓度与 ICH 患者死亡率之间的关联是一个新的发现。
