Blood-Based Biomarkers in Intracerebral Hemorrhage

Intracerebral hemorrhage (ICH) is one of the most lethal subtypes of stroke, associated with high morbidity and mortality. Prevention of hematoma growth and perihematomal edema expansion are promising therapeutic targets currently under investigation. Despite recent improvements in the management of ICH, the ideal treatments are still to be determined. Early stratification and triage of ICH patients enable the adjustment of the standard of care in keeping with the personalized medicine principles. In recent years, research efforts have been concentrated on the development and validation of blood-based biomarkers. The benefit of looking for blood candidate markers is obvious because of their acceptance in terms of sample collection by the general population compared to any other body fluid. Given their ease of accessibility in clinical practice, blood-based biomarkers have been widely used as potential diagnostic, predictive, and prognostic markers. This review identifies some relevant and potentially promising blood biomarkers for ICH. These blood-based markers are summarized by their roles in clinical practice. Well-designed and large-scale studies are required to validate the use of all these biomarkers in the future.

A Novel 10-Point Score System to Predict Early Hematoma Growth in Patients With Spontaneous Intracerebral Hemorrhage

Background: A rapid and reliable method to predict significant early hematoma growth in the acute setting is of great important to better inform clinicians and researchers in their efforts to improve outcomes for patients.

Methods: We established a 10-point score system to predict hematoma growth including four parameters: baseline intracerebral hemorrhage (ICH) volume > 30 mL, time to initial CT scan ≤ 3 h, island sign and black hole sign. Then, we reviewed our ICH database and assessed the predict value of the score system.

Results: A total of 216 ICH patients were included. Patients with hematoma growth at 24 h had higher score than those without hematoma growth (7.6 ± 3.0 vs. 2.0 ± 2.4, p < 0.001). The optimal cut-off value of the score for predicting hematoma growth was 3 (area under curve, 0.937; 95% CI, 0.899–0.975, p < 0.001), with 95% CI of 0.896–0.965 in bootstrapping analysis. The sensitivity, specificity, positive predictive and negative predictive value of the score ≥ 3 for predicting hematoma growth were 97.8, 92.7, 90.9, and 98.3%.

Conclusion: The 10-point score system could predict hematoma growth with high accuracy.

Accuracy of the Blend Sign on Computed Tomography as a Predictor of Hematoma Growth after Spontaneous Intracerebral Hemorrhage: A Systematic Review

BACKGROUND

Hematoma growth is a strong independent predictor of poor outcome after intracerebral hemorrhage. However, there is no gold standard to accurately predict hematoma growth. Several noncontrast computed tomographic markers associated with hematoma growth have been reported recently. Blend sign, which is a new marker, has been reported in several studies and seems a particularly promising marker but lacks a standardized evaluation so far.

METHODS

A systematic review of published literature on blend sign and hematoma growth and clinical outcomes was conducted. Systematic review of best practices was followed, and study quality was assessed.

RESULTS

The 6 studies involved 1573 participants in this review. The prevalence of blend sign ranged from 8.70% to 38.46%. The sensitivity of blend sign to predict hematoma growth varied from 13.0% to 42.86%; the specificity varied from 88.51% to 95.5%. Blend sign showed lower sensitivity but superior specificity for prediction of hematoma growth. Four studies indicated that the presence of blend sign was an independent predictor of hematoma growth. Four studies showed that the prevalence of blend sign was significantly higher in patients with hematoma growth compared with those without hematoma growth (odds ratio, 9.33; 95% confidence interval, 5.20-16.74).

CONCLUSION

There was an association between blend sign and hematoma growth, but this finding is tentative in light of the fact that the number of included studies was relatively small.

Impact of blood pressure changes and course on hematoma growth in acute intracerebral hemorrhage

BACKGROUND AND PURPOSE

An association between high blood pressure (BP) in acute intracerebral hemorrhage (ICH) and hematoma growth (HG) has not been clearly demonstrated. Therefore, the impact of BP changes and course on HG and clinical outcome in patients with acute ICH was determined.

METHODS

In total, 117 consecutive patients with acute (<6 h) supratentorial ICH underwent baseline and 24-h CT scans, CT angiography for the detection of the spot sign and non-invasive BP monitoring at 15-min intervals over the first 24 h. Maximum and minimum BP, maximum BP increase and drop from baseline, and BP variability values from systolic BP (SBP), diastolic BP and mean arterial pressure (MAP) were calculated. SBP and MAP loads were defined as the proportion of readings >180 and >130 mmHg, respectively. HG (>33% or >6 ml), early neurological deterioration (END) and 3-month mortality were recorded.

RESULTS

Baseline BP variables were unrelated to either HG or clinical outcome. Conversely, SBP 180-load independently predicted HG (odds ratio 1.05, 95% CI 1.010-1.097, P = 0.016), whilst both SBP 180-load (odds ratio 1.04, 95% CI 1.001-1.076, P = 0.042) and SBP variability (odds ratio 1.2, 95% CI 1.047-1.380, P = 0.009) independently predicted END. Although none of the BP monitoring variables was associated with HG in the spot-sign-positive group, higher maximum BP increases from baseline and higher SBP and MAP loads were significantly related to HG in the spot-sign-negative group.

CONCLUSIONS

In patients with acute supratentorial ICH, SBP 180-load independently predicts HG, whilst both SBP 180-load and SBP variability predict END.