Introduction: Hypertensive intracerebral hemorrhage (ICH) causes disability and mortality around the world, especially in Asian populations. Previous biochemical studies on hypertensive ICH revealed that catecholamines and inflammatory cytokines such as interleukine-6 (IL-6) may play a role in hemorrhagic stroke. However, the correlation between these potential biomarkers and neurologic outcome has seldom been discussed. Therefore, we aimed to study whether the serum levels of catecholamines and IL-6 are associated with neurologic outcome in hypertensive ICH patients.
Methods: Hypertensive ICH patients admitted to our institute between February 2011 and January 2012 were included in the prospective study. Blood samples were collected once daily during the first week of ICH onset to determine serum levels of epinephrine, norepinephrine, and IL-6. The physiological parameters were also collected, including intracranial pressure (ICP) in patients who received an operation. These patients then received follow-up for 90 days, and the functional outcome was measured using the Barthel index. The primary outcome was the correlation between the serum biomarkers and functional outcomes at follow-up.
Results: Seventeen hypertensive ICH patients were enrolled in the present study; 5 of these patients received an operation to remove hematoma, and ICP monitors were placed. The present study revealed a trend of higher serum catecholamines levels during the first week in the poor functional outcome group, especially serum epinephrine. The serum IL-6 level did not show significant correlation with functional outcome. However, in the operative group, a negative relationship between the IL-6 and cerebral perfusion pressure was identified.
Conclusions: Serum catecholamines, especially epinephrine, were found to be potential biomarkers for predicting the neurologic outcome of hypertensive ICH patients.
Patient Care: By monitoring the serial change of serum catecholamines in patient with primary intracerebral hemorrhage, we could be alert to secondary cerebral injury or other cardiopulmonary complications in intensive care unit before brain CT or other subsequent image study. The therapy targeting the β-adrenergic receptor may have potential benefit and require further studies.
Learning Objectives: (1)Elevated serum levels of catecholamines are associated with a poor neurologic outcome in hypertensive ICH patients
(2)The serial change of serum catecholamines may help with evaluating the therapeutic effect of our treatment modality.