Serum Secreted Protein Acidic and Rich in Cysteine-Like 1 as a Biochemical Predictor for Prognosticating Clinical Outcomes After Acute Supratentorial Intracerebral Hemorrhage: A Prospective Cohort Study.

Background: Secreted protein acidic and rich in cysteine-like 1 (SPARCL1) regulates synaptic stability and is up-regulated during axonal regeneration. Here, serum SPARCL1 was determined for estimating severity and prognosticating early neurological deterioration (END) and functional outcomes of acute intracerebral hemorrhage (ICH). Methods: In this prospective observational cohort study of 156 patients with supratentorial ICH, blood samples of 53 were acquired not only at admission but also ad days 1, 3, 5, 7 and 10. Another group of 53 healthy controls were recruited. The modified Rankin Scale (mRS) scores of 3-6 at poststroke six months were regarded as poor prognosis. Results: As opposed to controls, serum SPARCL1 levels were markedly elevated during the early ten days after ICH, with the highest levels at days 1 and 3. Admission serum SPARCL1 levels were independently correlated with National Institutes of Health Stroke Scale scores and hematoma volume, were significantly increased in the order of six-month mRS scores from 0 to 6 and were independently correlated with six-month mRS scores. Serum SPARCL1 levels were linearly related to risks of poor six-month prognosis and END under restricted cubic spline, had significant efficiency under receiver operating characteristic (ROC) curve and were independently associated with END and poor prognosis. Subgroup analysis confirmed that no interactions existed for associations of serum SPARCL1 levels with other variables, such as age, gender and some specific vascular risk factors. END and poor prognosis prediction models integrating serum SPARCL1 were displayed using the two nomograms. The poor prognosis prediction model, but END prediction model not, performed well under calibration curve, decision curve and ROC curve. Conclusion: A substantial elevation of serum SPARCL1 levels during the early period after ICH is independently related to illness severity and poor neurological outcomes, thus signifying that serum SPARCL1 may appear as a prognostic biomarker of ICH.

Prognostic and predictive significance of serum soluble scavenger receptor A in acute primary basal ganglia hemorrhage: A prospective cohort study.

BACKGROUND: Scavenger receptor A (SRA) can regulate immune response and is involved in pathophysiological processes of acute brain injury. We analyzed the prognostic role of serum soluble SRA in intracerebral hemorrhage (ICH). METHODS: In this prospective cohort study of 110 healthy controls and 110 patients with acute basal ganglia hemorrhage, serum soluble SRA concentrations were detected. Univariate analyses, followed by multivariate logistic regression analyses, were utilized to explore the relationship between serum soluble SRA concentrations and early neurologic deterioration (END) plus post-stroke 3-month poor prognosis (modified Rankin Scale scores of 3-6). RESULTS: Serum soluble SRA concentrations of patients were significantly higher than those of controls (median, 3.6 vs 0.9 ng/ml; P < 0.001). Serum soluble SRA concentrations of patients were independently correlated with hematoma volume (ß, 0.201; 95 % confidence interval (CI), 0.093-0.309; P = 0.001), National Institutes of Health Stroke Scale (NIHSS) scores (ß, 0.118; 95 % CI, 0.024-0.213; P = 0.024), and 3-month modified Rankin Scale scores (ß, 0.148; 95 % CI, 0.063-0.232; P = 0.001). Serum soluble SRA concentrations independently predicted END and poor 3-month prognosis with odds ratio values of 1.394 (95 % CI, 1.024-1.899; P = 0.035) and 1.441 (95 % CI, 1.016-2.044; P = 0.040) respectively. Serum soluble SRA concentrations were efficiently predictive of the development of END (ROC AUC 0.746; 95 % CI, 0.631-0.861) and poor 3-month prognosis (AUC, 0.773; 95 % CI, 0.685-0.861). Serum soluble SRA concentrations significantly improved AUCs of NIHSS score and hematoma volume to 0.889 (95 % CI, 0.829-0.948; P = 0.035) and 0.873 (95 % CI, 0.811-0.936; P = 0.036) for prognostic prediction. The END predictive ability of serum sSRA concentrations combined with NIHSS score and ICH volume (AUC, 0.900; 95 % CI, 0.835-0.965) was significantly superior to those of NIHSS score (P = 0.020) and hematoma volume (P = 0.022). The prognostic predictive capability of serum sSRA concentrations combined with NIHSS score and ICH volume (AUC, 0.907; 95 % CI, 0.852-0.962) substantially exceeded those of NIHSS score (P = 0.009) and hematoma volume (P = 0.005). CONCLUSIONS: Serum soluble SRA concentrations may reflect illness severity and neurologic function after ICH, indicating serum soluble SRA may serve as a promising prognostic biochemical marker of ICH.

High Serum S100A12 Levels Predict Poor Outcome After Acute Primary Intracerebral Hemorrhage.

OBJECTIVE: Intracerebral hemorrhage (ICH) triggers an inflammatory cascade that damages brain tissues and worsens functional outcome. S100A12 functions to promote brain inflammation. We aimed to investigate the relationship between serum S100A12 levels and functional outcome in ICH patients. METHODS: Serum S100A12 levels were measured in 101 ICH patients hospitalized within 24 h after symptom onset. Poor functional outcome was defined as a modified Rankin scale of 3 or greater at 3 months after stroke. Early neurologic deterioration was defined as an increase of ≥4 points in the National Institutes of Health Stroke Scale (NIHSS) score or death at 24 hours from symptoms onset. RESULTS: High serum S100A12 levels were independently correlated with NIHSS score (t = 5.384, P < 0.001), hematoma volume (t = 4.221, P < 0.001) and serum C-reactive protein levels (t = 5.068, P < 0.001). Serum S100A12 levels were substantially higher in patients with a poor outcome (median, 66.5 versus 37.7 ng/mL; P < 0.001) or early neurological deterioration (median, 76.5 versus 40.1 ng/mL; P < 0.001) than in the other remainders, independently predicted a poor outcome (odds ratio, 1.035; 95% confidence interval, 1.007-1.064; P = 0.015) and early neurologic deterioration (odds ratio,1.032; 95% confidence interval, 1.003-1.060; P = 0.027), and significantly discriminated a poor outcome (area under curve, 0.794; 95% confidence interval, 0.702-0.868) and early neurologic deterioration (area under curve, 0.760; 95% confidence interval, 0.664-0.839) under receiver operating characteristic curve. CONCLUSION: High serum S100A12 levels at admission are highly associated with the extent of inflammatory response, severity, a poor functional outcome and early neurologic deterioration in ICH patients, substantializing serum S100A12 as a promising prognostic biomarker for ICH.

Prognostic value of admission serum glucose-phosphate ratio in predicting the 6-month outcome of patients with severe traumatic brain injury: A retrospective study.

BACKGROUND: Serum glucose-phosphate ratio has been revealed to be associated with severity and prognosis of aneurysmal subarachnoid hemorrhage. Objective of this study was to investigate the relationship between serum glucose-phosphate ratio and severe traumatic brain injury outcome. METHODS: Patients with severe traumatic brain injury were stratified in quartiles according to their serum glucose-phosphate ratio. Outcome parameters included mortality, overall survival and poor outcome defined as Glasgow outcome scale score of 1-3 at post-traumatic 6 months. Multiple logistic regression analysis was performed to evaluate the association between quartiles of serum glucose-phosphate ratio and outcome. RESULTS: Data from 105 patients were retrospectively reviewed. Glasgow coma scale score declined, Glasgow outcome scale score decreased, Rotterdam computed tomography classification were raised, mortality increased, overall survival probability reduced and percentage of poor outcome rose significantly with each quartile of serum glucose-phosphate ratio. After adjusting for other confounding factors, serum glucose-phosphate ratio according to quartiles was substantially related to 6-month mortality, overall survival and poor outcome. Under receiver operating characteristic curve, serum glucose-phosphate ratio showed a significantly high prognostic predictive capability. CONCLUSIONS: Serum glucose-phosphate ratio might be a potential variable that can reflect trauma severity and prognosis in patients with severe traumatic brain injury.

Determination of serum tissue kallikrein levels after traumatic brain injury.

BACKGROUND: Tissue kallikrein (TK) plays an important role in the kallikrein-kinin system. Its protective role has been demonstrated in traumatic brain injury (TBI). We attempted to determine relationship between serum TK levels and trauma severity in addition to clinical outcome in TBI. METHODS: We recruited 112 patients with severe TBI (Glasgow coma scale score < 9) and 112 controls. We configured 2 multivariate models to assess the relationship between serum TK levels and 30-day death. Its prognostic predictive ability was analyzed under receiver operating characteristic curve. RESULTS: TK levels were significantly lower in patients than in controls (median 0.148 mg/l, the upper - lower quartiles 0.121-0.185 vs. median 0.258 mg/l, the upper - lower quartiles 0.207-0.342, P < 0.001). TK levels were closely and positively correlated with Glasgow coma scale score (r = 0.550). TK levels <0.148 mg/l independently predicted 30-day mortality with odds ratio value of 4.752 (95% confidence interval (CI), 1.166-19.367) and 30-day overall survival with hazard ratio value of 3.698 (95% CI, 1.026-13.333). TK levels significantly discriminated 30-day mortality with area under curve of 0.822 (95% CI, 0.738-0.887). CONCLUSIONS: Serum TK can represent a potential predictor of clinical outcome in TBI patients.

Allergic Epidural Effusion Following Polyetheretherketone Cranioplasty.

Cranioplasty is a common procedure in neurosurgical practice. However, some complications may occur after the operation. We here presented a case of bilateral skull defect and underwent cranioplasty with polyetheretherketone (PEEK) prosthesis. The patient developed epidural effusion on both sides 7 days after surgery. The effusion was light yellow and transparent, and laboratory examinations revealed normal glucose level, negative bacteriological results, and increased IgG protein concentration. The effusion disappeared after treatment with dexamethasone and drainage. We speculated that the epidural effusion was because of delayed type allergic reactions after PEEK cranioplasty. However, further studies are needed to investigate its related mechanisms.

Serum myeloperoxidase concentrations for outcome prediction in acute intracerebral hemorrhage.

BACKGROUND: Oxidative stress is related to brain injury after spontaneous intracerebral hemorrhage (ICH). Myeloperoxidase (MPO) is a potent oxidizing enzyme. We tested the hypothesis that serum MPO concentrations are increased after ICH and they correlate with stroke severity and outcome. METHODS: Serum MPO concentrations were measured in 128 ICH patients and 128 controls. Odds ratios of dependent variables, including early neurological deterioration, hematoma growth, 1-week mortality, 6-month mortality, 6-month unfavorable outcome (modified Rankin Scale score > 2) and 6-month overall survival, were calculated and adjusted for age, sex, hematoma volume, National Institutes of Health Stroke Scale (NIHSS) score and vascular risk factors. RESULTS: As compared to the controls, the patients had significantly increased serum MPO concentrations. MPO concentrations of the ICH patients were strongly correlated with hematoma volume and NIHSS scores. Serum MPO were independently associated with the above-mentioned study points. Its area under receiver operating characteristic curve was equivalent to those of hematoma volume and NIHSS score. Moreover, serum MPO significantly improved the discriminatory ability of hematoma and NIHSS in predicting 6-month mortality and unfavorable outcome. CONCLUSIONS: Serum MPO concentrations rise in ICH patients and there is a correlation between MPO concentrations and severity or prognosis.

Serum cyclophilin A concentrations and prognosis of acute intracerebral hemorrhage.

BACKGROUND: Cyclophilin A is involved in brain injury. We investigated the relationship between serum cyclophilin A concentrations, hemorrhagic severity and clinical outcome in intracerebral hemorrhage (ICH). METHODS: We enrolled 105 ICH patients and 105 healthy individuals. Admission serum cyclophilin A concentrations were detected in ICH patients. Hemorrhagic severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) and hematoma volume. Modified Rankin Scale score > 2 was defined as a poor outcome. RESULTS: Serum cyclophilin A concentrations were significantly higher in patients than in controls. There was a close correlation of serum cyclophilin A concentrations with NIHSS scores and hematoma volume. Serum cyclophilin A emerged as an independent predictor for 6-month mortality, overall survival and poor outcome. Moreover, it had a strong discriminatory ability for 6-month mortality and poor outcome. Furthermore, it could significantly improve the prognostic predictive ability of NIHSS scores or hematoma volume alone. CONCLUSIONS: Increasted serum cyclophilin A concentrations are highly associated with stroke severity and prognosis after hemorrhagic stroke.

Detection of high serum concentration of CXC chemokine ligand-12 in acute intracerebral hemorrhage.

BACKGROUND: CXC chemokine ligand-12 (CXCL12), a member of the CXC chemokine subfamily, is involved in both focal angiogenesis and inflammatory reactions. We examined serum CXCL12 concentration in intracerebral hemorrhage (ICH) patients and its correlation to stroke severity and outcome. METHODS: The study was carried out on 105 ICH patients on 105 healthy controls. Serum samples were at admission obtained to measure CXCL12 concentrations. The National Institutes of Health Stroke Scale (NIHSS) and hematoma volume were recorded to assess stroke severity. RESULTS: As compared to the controls, CXCL12 concentrations were significantly increased in the patients. Also, non-survivors within 6months and patients with an unfavorable outcome (modified Rankin Scale score>2) at 6months had higher CXCL12 concentrations than other remaining ones. CXCL12 concentrations had positive correlation with NIHSS scores and hematoma volume. Serum CXCL12 significantly discriminated patients at risk of 6-month mortality and 6-month unfavorable outcome under receiver operating characteristic curve. Moreover, serum CXCL12 was independently associated with the mortality, overall survival and unfavorable outcome. CONCLUSIONS: Serum CXCL12 concentrations are enhanced after ICH and CXCL12 in serum has the potential to reflect severity and prognosis following hemorrhagic stroke.

The prognostic value of serum signal peptide-Cub-Egf domain-containing protein-1 concentrations in acute intracerebral hemorrhage.

BACKGROUND: Signal peptide-Cub-Epidermal growth factor domain-containing protein 1 (SCUBE1) in peripheral blood, which is identified as a marker for coagulation, was reported to be an independent predictor of poor outcome in some illnesses. We investigated the clinical utility of serum SCUBE1 in the prognosis of intracerebral hemorrhage (ICH). METHODS: A total of 128 consecutive patients, admitted to emergency service due to acute ICH, and 128 healthy individuals were included in this prospective study. The patients were followed up until 6months or death. An unfavorable outcome was defined as modified Rankin Scale score>2. RESULTS: Serum SCUBE1 concentration was markedly higher in patients than in controls and was associated with hematoma volume, National Institutes of Health Stroke Scale (NIHSS) score and blood platelet count. After adjustment for hematoma volume and NIHSS score, it was still related to early neurological deterioration, hematoma growth, 1-week mortality, 6-month mortality, 6-month unfavorable outcome and 6-month overall survival. Additionally, serum SCUBE1 significantly improved areas under receiver operating characteristic curve of hematoma volume and NIHSS score to predict 6-month unfavorable outcome. CONCLUSIONS: Increased serum SCUBE1 concentrations have close relation to increasing severity and poor prognosis of ICH.