Can brain natriuretic peptide, S100b, and interleukin-6 prognosticate the neurological consequences in Egyptian patients presented with supratentorial intracerebral hemorrhage?
- Department of Neurosurgery, Mansoura University Hospital, Dakahliya, Egypt.
- Department of Clinical Pathology, Faculty of Medicine, Mansoura University, Dakahliya, Egypt.
- Department of Neurology, Mansoura University Hospital, Mansoura, Dakahliya, Egypt.
Hany A. Fikry Eldawoody
Department of Neurology, Mansoura University Hospital, Mansoura, Dakahliya, Egypt.
DOI:10.25259/SNI_784_2020Copyright: © 2020 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Hany A. Fikry Eldawoody1, Mohammed Abdel Bari Mattar1, Abeer Mesbah2, Ashraf Zaher3, Mohammed Elsherif3. Can brain natriuretic peptide, S100b, and interleukin-6 prognosticate the neurological consequences in Egyptian patients presented with supratentorial intracerebral hemorrhage?. 22-Dec-2020;11:460
How to cite this URL: Hany A. Fikry Eldawoody1, Mohammed Abdel Bari Mattar1, Abeer Mesbah2, Ashraf Zaher3, Mohammed Elsherif3. Can brain natriuretic peptide, S100b, and interleukin-6 prognosticate the neurological consequences in Egyptian patients presented with supratentorial intracerebral hemorrhage?. 22-Dec-2020;11:460. Available from: https://surgicalneurologyint.com/surgicalint-articles/10485/
Background: Biomarkers in supratentorial intracerebral hemorrhage (SICH) enhance the prognosis of the disease. This study aimed to assess the prognosticative grade of S100 calcium-binding protein B (S100B), interleukin-6 (IL-6), and the pro-brain natriuretic peptide (pro-BNP) in SICH outcome prediction.
Methods: Blood samples of 50 SICH patients were analyzed for the biomarkers. The patients were classified into two groups with and without intraventricular hemorrhage (IVH). The following scales including Glasgow Coma Score (GCS), the Barthel index (BI), intracerebral hemorrhage (ICH) score, ICH volume, National Institutes of Health Stroke Scale (NIHSS), Modified Rankin Score (mRS), and length of stay were used to evaluate the severity.
Results: The severity scores (NIHSS, GCS, BI, mRI) were significantly higher in SICH patients with IVH versus SICH patients without IVH (P = 0.002, 0.008, 0.001, and 0.03, respectively). Serum levels for a pro-BNP and S100b are significantly higher in SICH patients with IVH versus SICH patients without IVH (P = 0.02 and 0.027, respectively). Multivariate correlations between demographic (age), biomarkers panel (IL-6, S100b, and proBNP), and clinical and severity scores (ICH score, ICH volume, length of hospital stay [LOS], BI, mRS, GCS, and NIHSSS) in all studied patients showed a highly significant correlation between ICH score and pro-BNP (P = 0.04). There was a highly significant correlation between LOS and IL-6 (P = 0.003).
Conclusion: Pro-BNP, IL-6, and S100b are greatly associated with the presence of IVH that, in turn, correlated well with poor clinical outcome measures.
Keywords: Interleukin-6, Outcome, Pro-brain natriuretic peptide, S100 calcium-binding protein b, Supratentorial intracerebral hemorrhage
A relatively common and overwhelming disease is the primary supratentorial intracerebral hemorrhage (SICH) accompanied by variable prognosis despite the great advancement in its related neurological and neurosurgical management.[
In this study, we assess the predictive value of the biomarker panel of S100b, IL-6, and pro-BNP, in the functional outcome after SICH, rather than conventional clinical and/or radiological methods.
The present prospective study included 50 patients with SICH who were admitted to the neurosurgery/neurology departments over a 12-month period at Mansoura Emergency University Hospital, Egypt. The diagnosis was based on clinical assessment and computed tomographic (CT) head scanning immediately after the onset of the condition. All patients were assessed by taking a medical history, history of previous cerebrovascular strokes, hypertension, diabetes mellitus, and renal or hepatic disorders.
A consent whether informed or written was obtained from each patient and the ethical committee also approved the study.
Clinical assessment scales
Clinical examination besides the neurological severity scales for the assessment of functional outcome at the discharge time was evaluated by Glasgow Coma Score (GCS), the Barthel index (BI), intracerebral hemorrhage score (ICHS), National Institutes of Health Stroke Scale (NIHSS), and Modified Rankin Score (mRS). GCS, BI, NIHSS, mRS, and ICHS results were tabulated. The ICHS is a validated 6-point score to evaluate risk in patients with SICH and includes initial GCS, hematoma location, and volume, whether intraventricular hematoma is present or not, and the age.[
Within the initial 24 h after hospital admission, the studied group of patients was scanned using brain computed tomography and checked for hemorrhagic volume (cm3), presence of intraventricular hemorrhage (IVH), and midline shift (MLS). On discharge from Mansoura University Hospital, we used the following functional assessment scales; BI, length of hospital stay (LOS), and mRS, by a blinded observer evaluation method as they are the best for biomarker panel data. All studied patients showed CT-proven supratentorial ICH before taking the blood samples. Regarding the CT scans evaluation, a blinded neuroradiologist used the well-known simplified ellipsoid volume equation method described by Kothari et al.[
About 8 ml venous blood was withdrawn from each patient and divided as follows: 2 ml into EDTA tube for complete blood picture, 1.8 ml into the citrated tube for prothrombin time and APTT, and the remaining blood into the plain tube to get sera for routine investigations and the remaining sera were divided into three aliquots which were stored frozen at –20°C till the time of assay of specific investigations: S100 protein, IL-6, and N-terminal-pro-BNP. The routine laboratory investigations included complete blood picture, random blood sugar, liver, kidney function tests, and coagulation tests: PT and APTT. All routine laboratory chemical tests were done by fully automated chemistry analyzer Cobas c 311 (Roche Diagnostic GmbH Mannheim, Germany). A complete blood picture was done by Cell Dyn 1800, Abbott, USA. Coagulation tests were done by Siemens reagents using the Coatron Coagulometer, Germany. Quantitative determination of IL-6 was done by the enzyme-linked immunosorbent assay (ELISA) technique using RayBio Kit, Cat # ELH-IL6-001, USA.[
The mean and standard deviation were used for the description of continuous variables, while percentages were used for categorical variables. The linear regression curve was used to express the correlation of CT outcomes to the biomarkers panel. The relationship between the biochemical markers panel and functional patient scores was assessed by the linear regression analysis for the BI. The mRS was evaluated as a dichotomous outcome, while the BI was evaluated as a continuous variable. Logistic regression analysis was done for mRS. Multivariate assumptions were used. The two-way interactions between covariates were used for additive effects. The tolerance and variance inflation tests were used to show the collinearity between the predictors. The SAS software version 9.3 or JMP 7.0.1 was used for the execution of those statistics.
The studied patients’ group comprised 50 patients with predominant male gender, with male-to-female ratio of 16:9 ≅ 1.7:1 patient. The mean age (in years) of the studied group was 60.7 ± 11.5. The studied SICH patients were subdivided into two groups based on the presence or absence of IVH.
Severity scores results
The severity scores (NIHSS, GCS, BI, and mRS) were significantly higher in SICH patients with IVH when compared with SICH patients without IVH (P = 0.002, 0.008, 0.001, and 0.03, respectively), while the LOS score did not show any statistical significance [
Serum levels for a panel of blood biomarkers (pro-BNP and S100b) were significantly higher in SICH patients with IVH when compared with SICH patients without IVH (P = 0.02 and 0.027, respectively). The IL-6 did not show any statistical significance [
Correlations between clinical data, laboratory results, and severity scores
Multivariate correlations between demographic (age), biomarkers panel (IL-6, S100b, and pro-BNP), and clinical and severity scores (ICH score, ICH volume, LOS, BI, mRS, GCS, and NIHSSS) in all studied patients showed a highly significant correlation between ICH score and proBNP (P = 0.04). Moreover, there was a highly significant correlation between LOS and IL-6 (P = 0.003) [
Many studies have shown that there is a correlation between the biochemical marker panels and the prognosis in various acute onset brain lesion pathogenesis, such as ischemic stroke,[
Pro-BNP, IL-6, and S100b are greatly associated with the presence of IVH that correlated well with poor clinical outcome measures by NIHSSS, GCS, BI, and mRS. Moreover, these contribute to the prognostic biomarkers data over the severity scales that integrate both the clinical and radiographic characteristics. Nevertheless, those laboratory biomarkers added more prognostic value when conjoined with clinical severity scores, especially ICH score and proBNP. Further investigation of serial serum biomarkers measurements could be of value over a prolonged period, especially with the addition of cognitive function evaluation.
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