Leonardo Lorente1, María M Martín2, Antonia Pérez-Cejas3, Agustín F González-Rivero3, Rafael Sabatel4, Luis Ramos5, Mónica Argueso6, Jordi Solé-Violán7, Juan J Cáceres8, Alejandro Jiménez9, Victor García-Marín10. 1. Intensive Care Unit, Hospital Universitario de Canarias, Ofra s/n, La Laguna, 38320, Santa Cruz de Tenerife, Spain. lorentemartin@msn.com. 2. Intensive Care Unit, Hospital Universitario Nuestra Señora de Candelaria, Crta del Rosario s/n, 38010, Santa Cruz de Tenerife, Spain. 3. Laboratory Department, Hospital Universitario de Canarias, Ofra s/n, La Laguna, 38320, Santa Cruz de Tenerife, Spain. 4. Department of Radiology, Hospital Universitario de Canarias, Ofra s/n, La Laguna, 38320, Santa Cruz de Tenerife, Spain. 5. Intensive Care Unit, Hospital General La Palma, Buenavista de Arriba s/n, 38713, Breña Alta, La Palma, Spain. 6. Intensive Care Unit, Hospital Clínico Universitario de Valencia, Avda. Blasco Ibáñez no 17-19, 46004, Valencia, Spain. 7. Intensive Care Unit, Hospital Universitario Dr. Negrín, CIBERES, Barranco de la Ballena s/n, 35010, Las Palmas de Gran Canaria, Spain. 8. Intensive Care Unit, Hospital Insular, Plaza Dr. Pasteur s/n, 35016, Las Palmas de Gran Canaria, Spain. 9. Research Unit, Hospital Universitario de Canarias, Ofra s/n, La Laguna, 38320, Santa Cruz de Tenerife, Spain. 10. Department of Neurosurgery, Hospital Universitario de Canarias, Ofra s/n, La Laguna, 38320, Santa Cruz de Tenerife, Spain.
Abstract
BACKGROUND: Apoptotic cell death leads to secondary brain injury after spontaneous intracerebral hemorrhage (SIH). There is an association between serum caspase-3 levels and late mortality (at 6 months) in patients with SIH in basal ganglia. The new objective of this study was to determine whether there exists an association between serum caspase-3 levels and early mortality (at 30 days) in patients with SIH at different sites and not only in basal ganglia. METHODS: Patients with severe supratentorial SIH (defined as Glasgow Coma Scale < 9) admitted in 6 Spanish hospitals were included in this observational and prospective study. Patients with SIH due to aneurysm, arteriovenous malformation, and anticoagulant or fibrinolytic treatment were excluded. Serum caspase-3 levels at days 1, 4, and 8 of SIH were determined. Thirty-day mortality was the end-point study. RESULTS: Non-surviving (n = 53) showed higher serum caspase-3 levels at days 1 (p < 0.001), 4 (p < 0.001), and 8 (p < 0.001) than survivor patients (n = 64). Multiple logistic regression analysis showed an association of serum caspase-3 levels > 0.167 ng/mL with 30-day mortality (Odds Ratio = 47.007; 95% CI = 4.838-456.727; p = 0.001). CONCLUSIONS: The new findings of our study are that serum caspase-3 levels are associated with early mortality in patients with severe supratentorial SIH at different sites and that those levels during the first week of SIH are higher in non-survivors than in survivors.
BACKGROUND: Apoptotic cell death leads to secondary brain injury after spontaneous intracerebral hemorrhage (SIH). There is an association between serum caspase-3 levels and late mortality (at 6 months) in patients with SIH in basal ganglia. The new objective of this study was to determine whether there exists an association between serum caspase-3 levels and early mortality (at 30 days) in patients with SIH at different sites and not only in basal ganglia. METHODS:Patients with severe supratentorial SIH (defined as Glasgow Coma Scale < 9) admitted in 6 Spanish hospitals were included in this observational and prospective study. Patients with SIH due to aneurysm, arteriovenous malformation, and anticoagulant or fibrinolytic treatment were excluded. Serum caspase-3 levels at days 1, 4, and 8 of SIH were determined. Thirty-day mortality was the end-point study. RESULTS: Non-surviving (n = 53) showed higher serum caspase-3 levels at days 1 (p < 0.001), 4 (p < 0.001), and 8 (p < 0.001) than survivor patients (n = 64). Multiple logistic regression analysis showed an association of serum caspase-3 levels > 0.167 ng/mL with 30-day mortality (Odds Ratio = 47.007; 95% CI = 4.838-456.727; p = 0.001). CONCLUSIONS: The new findings of our study are that serum caspase-3 levels are associated with early mortality in patients with severe supratentorial SIH at different sites and that those levels during the first week of SIH are higher in non-survivors than in survivors.
Authors: Adnan I Qureshi; M Fareed K Suri; Peter T Ostrow; Stanley H Kim; Zulfiqar Ali; Ahmed A Shatla; Lee R Guterman; L Nelson Hopkins Journal: Neurosurgery Date: 2003-05 Impact factor: 4.654