Early Predictors of Outcome in Taiwanese Patients with Spontaneous Intracerebral Hemorrhage

Background: The volume of intracerebral hemorrhage (ICH), Glasgow Coma Scale (GCS) score, peripheral relative edema around the hematoma, and hydrocephalus are all good early predictors of mortality in spontaneous ICH patients from Western Countries. However, the significance of hematological and biochemical parameters associated with spontaneous ICH has not been extensively studied. The first purpose of this study was to determine the prognostic factors of spontaneous ICH in Taiwanese patients.
Inducible Heat shock proteins 70 (HSP70) is a stress protein whose expression is upregulated when cell or organism is placed under condition of stress and detected in the central nervous system. The tumor necrosis factor alpha (TNF-? and Interleukin-18 (IL-18) are multi-potential cytokines with early inflammatory properties and detected in the central nervous system and peripheral blood. Interleukin-11 (IL-11) is a multi-potential cytokine with anti-inflammatory and fibrogenic properties. It is detected in the central nervous system. The second purpose of this study was to determine plasma and cerebral spinal fluid (CSF) levels of HSP70, IL-18, TNF-? and IL-11 in patients with spontaneous ICH and to correlate these cytokines with related edema of brain, hydrocephalus, and severity of disease.
Methods: We prospectively studied 109 consecutive patients with spontaneous ICH between September 2002 and June 2003 admitted to surgical intensive care units of Changhua Christian Medical Center in central Taiwan. Clinical and laboratory data were collected and analyzed. The plasma and CSF samples were collected on the first, second, third and fourth day after spontaneous ICH onset.
Results: The mean age of our patients was 62.3±13.7 years. There were 63 men (58%) and 46 women (42%). The differences in GCS score and ICH score between the survival and non-survival groups were statistically different. Laboratory data was statistically different between the two groups for platelet count, prothrombin time (International Normal Ratio (INR)), and blood glucose levels using multivariate analysis. The m-RNA of HSP70, IL-18, and TNF-?continued expressed in peripheral mononuclear cells after spontaneous ICH onset. The levels of TNF-?in CSF were higher than in plasma. The levels of IL-18 in CSF were about one-fourth of that in plasma. The levels of IL-18 in plasma were significantly higher than in CSF, but did not associate with mortality. On the first day of spontaneous ICH, plasma levels of TNF-?and HSP70 were significantly higher than in the non-survival group. Plasma levels of IL-11 in the non-survival group were significantly higher than those in the survival group after the second day of ICH onset. In the hydrocephalus group, plasma levels of IL-11 were significantly higher than these of the non-hydrocephalus group on the fourth day. The volume of hematoma had a statistical correlation with plasma IL-11 on the third day.
Conclusions: This is the first study providing information on predictors of spontaneous ICH mortality in Taiwanese patients. The prothrombin time and platelet count on the first day were good early predictors of mortality. This finding in Taiwanese patients is different from the picture in patients from Western Countries. TNF-? and HSP 70 were released to the peripheral blood from the damaged brain and highly associated with mortality in spontaneous ICH patients. We believed that TNF-? and HSP70 could be useful predictors of outcome in spontaneous ICH patients. IL-11 was highly associated with mortality of spontaneous ICH, and predicted the hydrocephalus occurring after ICH onset. We believed that IL-11 could be a useful clinical maker for spontaneous ICH patients.