Introduction: Intracerebral hemorrhage (ICH) is a devastating disease, and is associated with higher mortality and morbidity than any other type of stroke. Inflammation has been linked to cell death and secondary injury in the setting of ICH. We sought to create an inflammatory profile in an ICH cohort by measuring serum levels of a number of inflammatory biomarkers.
Methods: Blood serum samples were collected for 44 patients presenting to the Columbia Neuro-ICU with non-traumatic ICH. For each patient, the following biomarkers were measured in serum: SAA, IL-5, IL-6, IL-7, IL-8, IL-10, and TNF-a. Samples were pooled by post-bleed day (PBD) as follows: PBD 0, PBD 1, PBD 2-3, PBD 4-7, PBD 8-11, and PBD 12-15. Seventeen patients had available samples for PBD 0, 34 for PBD 1, 40 for PBD 2-3, 38 for PBD 4-7, 28 for PBD 8-11, and 22 for PBD 12-15. Levels of each inflammatory marker at each pooled sample were compared to a healthy control population (11 subjects) via Wilcoxon rank sum test. False discovery rate was controlled for multiple comparisons using the Benjamini and Hochberg method.
Results: Every biomarker was elevated in the ICH cohort vis-à-vis the control cohort on PBD 4-7, and the difference between the ICH and control cohorts was greatest at this point for each biomarker. This was the only point where TNF-a levels were significantly higher; on the other hand, IL-6, IL-8, and IL-10 were elevated in the ICH cohort at each time point.
Conclusions: In this study we demonstrate elevated levels of a number of inflammatory biomarkers in ICH patients with respect to controls. Our results suggest 4 to 7 days post-ictus as the point where inflammation may be highest. Inflammatory biomarkers in the setting of ICH remain an important potential avenue for future research.
Patient Care: We hope to eventually find an accepted therapy for ICH by elucidating the mechanisms of inflammation and secondary injury.
Learning Objectives: By the end of this session, participants should be able to 1) describe the importance of inflammation in the setting of ICH, 2) identify the point of peak inflammation.