Abstract
Background The prognostic significance of serum biomarkers in patients with intracerebral hemorrhage
(ICH) is not well investigated concerning inhospital mortality (IHM) and cardiopulmonary
events within the first 24 hours of intensive care unit (ICU) treatment. The influence
of troponin I (TNI) value and cortisol value (CV) on cardiopulmonary events within
the first 24 hours of ICU treatment was reported in subarachnoid hemorrhage patients,
but not in ICH patients up to now. The aim of this study was to investigate the role
of early serum biomarkers on IHM and TNI value and CV on cardiopulmonary events within
the first 24 hours of ICU treatment.
Patients and Methods A total of 329 patients with spontaneous ICH were retrospectively analyzed. Blood
samples were taken on admission to measure serum biomarkers. The TNI value and CV
were defined as biomarkers for cardiopulmonary stress. Demographic data, cardiopulmonary
parameters, including norepinephrine application rate (NAR) in microgram per kilogram
per minute and inspiratory oxygen fraction (FiO2) within the first 24 hours, and treatment regime were analyzed concerning their impact
on ICU treatment and in hospital outcome. Binary logistic analysis was used to identify
independent prognostic factors for IHM.
Results Patients with initially nonelevated CVs required higher NAR (p = 0.01) and FiO2 (p = 0.046) within the first 24 hours of ICU treatment. Lower cholinesterase level (p = 0.004), higher NAR (p = 0.002), advanced age (p < 0.0001), larger ICH volume (p < 0.0001), presence of intraventricular hemorrhage (p = 0.007) and hydrocephalus (p = 0.009), raised level of C-reactive protein (p = 0.024), serum lactate (p = 0.003), and blood glucose (p = 0.05) on admission were significantly associated with IHM. In a multivariate model,
age (odds ratio [OR]: 1.055; 95% confidence interval [CI]: 1.026–1.085; p < 0.0001), ICH volume (OR: 1.016; CI: 1.008–1.025; p < 0.0001), and Glasgow Coma Scale (GCS) score (OR: 0.680; CI: 0.605–0.764; p < 0.0001) on admission as well as requiring NAR (OR: 1.171; CI: 1.026–1.337; p = 0.02) and FiO2 (OR: 0.951; CI: 0.921–0.983, p = 0.003) within the first 24 hours were independent predictors of IHM.
Conclusion Higher levels of C-reactive protein, serum lactate, blood glucose, and lower cholinesterase
level on admission were significantly associated with IHM. Patients with initially
nonelevated CVs required higher NAR and FiO2 within the first 24 hours of ICU treatment. Furthermore, requiring an NAR > 0.5 µg/kg/min
or an FiO2 > 0.21 were identified as additional independent predictors for IHM. These results
could be helpful to improve ICU treatment in ICH patients.
Keywords
intrahospital mortality - biomarker - ICU treatment - intracerebral hemorrhage
