Predictive value of serum caspase-cleaved cytokeratin-18 concentrations after acute intracerebral hemorrhage.

BACKGROUND: Caspase-cleaved Cytokeratin-18 (CCCK-18) is released during apoptosis. Serum CCCK-18 concentrations are associated with prognosis of some critical illness. We investigated the potential relationships between serum CCCK-18 concentrations and disease severity and long-term clinical outcomes after intracerebral hemorrhage. METHODS: Serum CCCK-18 concentrations were determined in a total of 102 patients and 102 controls. Multivariate models were used to predict high concentration of CCCK-18 and 6-month clinical outcomes. The predictive values were evaluated based on areas under receiver operating curve. RESULTS: Compared with controls, serum CCCK-18 concentrations were increased in patients (245.8±108.3U/l vs. 23.6±18.1U/l, P<0.001). National Institute of Health Stroke Scale scores [odds ratio (OR), 1.164; 95% confidence interval (CI), 1.027-1.320; P=0.003] and hematoma volumes (OR, 1.079; 95% CI, 1.018-1.205; P=0.008) were independent predictors of high concentration of CCCK-18. CCCK-18 was identified as an independent predictor of 6-month mortality (OR, 1.019; 95% CI, 1.010-1.038; P=0.013) and 6-month unfavorable outcome (OR, 1.017; 95% CI, 1.008-1.029; P=0.032) and possessed high predictive values. CONCLUSION: Increased serum CCCK-18 concentrations are associated with disease severity and clinical outcomes, suggesting that CCCK represent a novel prognostic predictive biomarker after intracerebral hemorrhage.

Admission plasma visfatin level strongly correlates with hematoma growth and early neurologic deterioration in patients with acute spontaneous basal ganglia hemorrhage.

BACKGROUND: Visfatin, a proinflammatory mediator, has been associated with poor clinical outcomes after acute brain injury. The present study is designed to investigate the potential association between plasma visfatin levels and the risk of hematoma growth (HG) and early neurologic deterioration (END) after intracerebral hemorrhage. METHODS: There were 85 patients as cases who presented with first-time hemorrhagic stroke that were assessed within 6h after the incident. The control group consisted of 85 healthy volunteers. HG was defined as hematoma enlargement >33% at 24h. END was defined as an increase of ≥ 4 points in National Institute of Health Stroke Scale score at 24h from symptoms onset. Plasma visfatin levels were determined using enzyme immunoassay. RESULTS: Plasma visfatin levels were significantly higher in patients compared to controls. Plasma visfatin level emerged as an independent predictor of HG [odds ratio (OR), 1.154; 95% confidence interval (CI), 1.046-3.108; P=0.009] and END (OR, 1.195; 95% CI, 1.073-3.516; P=0.005). For predicting HG, area under curve (AUC) of plasma visfatin level (0.814; 95% CI: 0.715-0.890) was similar to that of hematoma volume (0.839; 95% CI, 0.743-0.909) (P=0.703). For predicting END, AUC of plasma visfatin level (0.828; 95% CI: 0.730-0.901) was similar to that of hematoma volume (0.863; 95% CI, 0.771-0.928) (P=0.605). Visfatin did not improve AUC of hematoma volume for predicting HG and END (both P>0.05). CONCLUSION: Plasma visfatin level represents a novel biomarker for predicting HG and END.

[Clinical study on the early nutrition support in postoperative patients with critical hypertensive intracerebral hemorrhage].

OBJECTIVE: To investigate the clinical significance of early nutritional support for patients with critical hypertensive intracerebral hemorrhage (HICH) in a critical condition after operation, and the rationale of different methods of nutritional support. METHODS: One hundred and seven HICH patients after operation with Glasgow coma score (GCS) 6-8 were randomly divided into three groups: early enteral nutrition (EEN) group (38 cases); early parenteral nutrition (EPN) group (35 cases), conventional treatment controls (34 cases). They were given different nutritional supports 48 hours after operation. Changes in nutritional parameters and the clinical complications in three groups after treatment were observed, and the treatment effects after 3 months were compared. RESULTS: At the end of first week after operation, nutrition parameters including albumin (ALb), hemoglobin (Hgb) in EEN and EPN groups were better than those in control group(P<0.05); at the end of second week, they were differences among three groups but without statistical significance (P>0.05). The complications were higher in EPN and control groups (P<0.05 or P<0.01). The outcome was assessed 3 months after the operation in term of activity of daily life (ADL), and the result was better in EEN group than that in EPN and control groups (P<0.005). CONCLUSION: Postoperative HICH patients in critical condition could be benefited with EEN, and complications could be reduced with improved prognosis.

[Study on clinical significances of the application of nasotracheal intubation guided with fiberbronchoscope to the postoperative patients with hypertensive intracerebral hemorrhage].

OBJECTIVE: To explore the clinical signification of the application of nasotracheal intubation guided with fiberbronchoscope to the postoperative patients with hypertensive intracerebral hemorrhage (HICH) who had respiration failure. METHODS: Ninety-four postoprative patients with HICH were divided into two groups, A group treated with nasotracheal intubation and B group treated with tracheal incision. The oxygen metabolism, pulmonary complication incidence of two groups were analyzed and compared. RESULTS: The basic oxygen metabolism and the need of mechanical ventilation in the cases with respiration failure were satisfying in two groups (both P>0.05). The mean reserved time of artificial airway in A group was(14.2+/-6.5)days, which in B group was(19.1+/-7.2)days (P<0.01). The occurent rates of combined infection in lung and double-infection were lower in A group than these in B group (56.3 percent vs. 91.3 percent, P<0.05; 10.4 percent vs. 39.1 percent, P<0.01; respectively), with their resident days shorter and prognosis better in A group than these in B group (P<0.05). CONCLUSION: The nasotracheal intubation guided with fiberbronchoscope has small trauma, lower incidence of complication, which may be considered as a better selection for the postoperative patients with HICH who had respiration failure.