Department of Neurological Surgery, Albert Einstein College of Medicine, 1410 Pelham Parkway South, Rose F. Kennedy Center, Bronx, NY, 10461, USA.
Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresthill, Aberdeen, UK.
J Neurol. 2022 Dec;269(12):6330-6341. doi: 10.1007/s00415-022-11284-8. Epub 2022 Jul 22.
Accumulating evidence suggests that spontaneous intracerebral hemorrhage (ICH) is associated with a reactive neuroinflammatory response. However, it remains unclear if circulating inflammatory biomarkers are associated with adverse outcomes in ICH. To address this knowledge gap, we conducted a cohort study using a prospectively maintained stroke register in the United Kingdom to assess the prognostic value of admission inflammatory biomarkers in ICH.
The Norfolk and Norwich Stroke and TIA Register recorded consecutive ICH cases. The primary exposures of interest were elevation of white cell count (WCC; > 10 × 10/L), elevation of c-reactive protein (CRP; > 10 mg/L), and co-elevation of both biomarkers, at the time of admission. Modified Poisson and Cox regressions were conducted to investigate the relationship between co-elevation of WCC and CRP at admission and outcomes following ICH. Functional outcome, multiple mortality timepoints, and length of stay were assessed.
In total, 1714 ICH cases were identified from the register. After adjusting for covariates, including stroke-associated pneumonia, co-elevation of WCC and CRP at admission was independently associated with significantly increased risk of poor functional outcome (RR 1.08 [95% CI 1.01-1.15]) and inpatient mortality (RR 1.21 [95% CI 1.06-1.39]); and increased 90-day (HR 1.22 [95% CI 1.03-1.45]), and 1-year mortality (HR 1.20 [95% CI 1.02-1.41]). Individual elevation of WCC or CRP was also associated with poor outcomes.
Elevated inflammatory biomarkers were associated with poor outcomes in ICH. This study indicates that these readily available biomarkers may be valuable for prognostication and underscore the importance of inflammation in ICH.
越来越多的证据表明，自发性脑出血（ICH）与反应性神经炎症反应有关。然而，目前尚不清楚循环炎症生物标志物是否与 ICH 的不良结局相关。为了填补这一知识空白，我们在英国进行了一项队列研究，使用前瞻性维护的卒中登记处来评估入院时炎症生物标志物对 ICH 的预后价值。
诺福克和诺维奇卒中与 TIA 登记处记录了连续的 ICH 病例。主要关注的暴露因素是白细胞计数升高（WCC；＞10×10/L）、C 反应蛋白升高（CRP；＞10mg/L）以及两者同时升高。采用修正泊松回归和 Cox 回归来探讨入院时 WCC 和 CRP 同时升高与 ICH 后结局之间的关系。评估了功能结局、多个死亡时间点和住院时间。
从登记处共确定了 1714 例 ICH 病例。在校正包括卒中相关性肺炎在内的协变量后，入院时 WCC 和 CRP 同时升高与不良功能结局（RR 1.08[95%CI 1.01-1.15]）和住院期间死亡率（RR 1.21[95%CI 1.06-1.39]）的风险显著增加相关；与 90 天（HR 1.22[95%CI 1.03-1.45]）和 1 年死亡率（HR 1.20[95%CI 1.02-1.41]）的增加相关。WCC 或 CRP 的单独升高也与不良结局相关。
升高的炎症生物标志物与 ICH 的不良结局相关。本研究表明这些易于获得的生物标志物可能对预后具有重要价值，并强调了炎症在 ICH 中的重要性。
