Determination of serum neutrophil gelatinase-associated lipocalin as a prognostic biomarker of acute spontaneous intracerebral hemorrhage.

BACKGROUND: Neutrophil gelatinase-associated lipocalin (NGAL) is currently known as an acute phase protein and implicated in acute brain injury. Herein, we sought to gauge serum NGAL level in patients after acute (<24 h) spontaneous intracerebral hemorrhage (ICH) and to investigate its relation to neurological outcome. METHODS: Serum NGAL levels were measured in 106 patients and 106 controls. National Institutes of Health Stroke Scale (NIHSS) score, Glasgow coma scale (GCS) score, ICH score and hematoma volume were recorded for assessing hemorrhagic severity. An unfavorable outcome was defined as modified Rankin Scale >2 at 90 days. RESULTS: As opposed to the controls, the patients had significantly raised serum NGAL levels. Correlations were observed between NGAL levels and serum C-reactive protein levels, blood glucose levels, GCS score, NIHSS score, ICH score and ICH volume. Multivariate analysis identified serum NGAL as a predictor for unfavorable outcome at 90 days. It also showed high prognostic ability under receiver operating characteristic curve. CONCLUSIONS: Enhanced NGAL level is revealed after acute spontaneous ICH, in association with inflammatory degree and hemorrhagic severity, and intimately correlated with a worse prognosis.

Serum S100A12 and 30-day mortality after acute intracerebral hemorrhage.

BACKGROUND: S100A12 is implicated in inflammatory reactions. The purpose of this study was to determine the association between serum S100A12 concentrations and 30-day mortality in patients with acute intracerebral hemorrhage (ICH). METHODS: We prospectively included 182 healthy controls and 182 ICH patients within 24h after stroke onset. Serum samples were collected for the measurement of S100A12 concentrations. Multivariable analysis was used to evaluate the relationship between serum S100A12 concentrations and mortality of ICH patients within 30days. RESULTS: Serum S100A12 concentrations were significantly increased compared to control subjects. S100A12 concentrations were positively correlated with National Institutes of Health Stroke Scale (NIHSS) score, ICH volume, blood glucose concentrations, blood white blood cell count and plasma C-reactive protein concentrations. 36 (19.8%) patients were deceased within 30days after stroke onset. Non-survivors had significantly higher concentrations of serum S100A12 than survivors. Additionally, Serum S100A12 concentrations significantly discriminated patients at risk of 30-day mortality and its predictive value was equivalent to those of NIHSS score and hematoma volume. Moreover, higher serum S100A12 concentrations showed a significantly higher risk for 30-day mortality and overall survival. CONCLUSIONS: Higher S100A12 concentrations are positively associated with inflammation, hemorrhagic severity and short-term mortality among ICH patients, indicating S100A12 may represent a biomarker for predicting poor outcome after hemorrhagic stroke.

Prognostic value of serum thioredoxin concentrations after intracerebral hemorrhage.

BACKGROUND: Thioredoxin (TRX) is a potent anti-oxidant and its circulating concentration is increased in some critical illnesses. We measured the serum TRX concentrations and further investigated the relationship between serum TRX concentrations and hemorrhagic severity and outcome after intracerebral hemorrhage (ICH). METHODS: A total of 218 ICH patients and 218 healthy controls were enrolled in this prospective, observatory study. Serum TRX concentrations were determined using an enzyme-linked immunosorbent assay. Hemorrhagic severity was assessed with National Institutes of Health Stroke Scale (NIHSS) score and hematoma volume. Clinical endpoint was 6-month mortality. RESULTS: Compared with the controls, the patients had elevation of serum TRX concentrations (24.4±11.5 ng/ml vs. 8.4±3.3 ng/ml, P<0.001). Serum TRX concentrations were highly related to NIHSS score (r=0.532, P<0.001) and hematoma volume (r=0.486, P<0.001). Serum TRX concentrations higher than 29.6 ng/ml was an independent predictor of 6-month mortality (odds ratio, 3.978; 95% confidence interval, 1.486-10.649) and 6-month overall survival (hazard ratio, 3.511; 95% confidence interval, 1.827-6.746). TRX concentrations improved the predictive value of NIHSS score and hematoma volume for 6-month mortality. CONCLUSIONS: Increased serum TRX concentration, related closely to hemorrhagic severity and long-term mortality, has the potential to be a novel prognostic predictive biomarker after ICH.