Biomarkers of Functional Outcome in Intracerebral Hemorrhage: Interplay between Clinical Metrics, CD163, and Ferritin

Background: Intracerebral hemorrhage (ICH) is associated with neurological decline and poor prognosis. Although many etiologic models have been explored, secondary damage caused by continued inflammation and iron exposure from red blood cell lysis may explain poor outcomes at distant follow-up. Examining serum samples of patients with ICH for biomarkers of iron physiology may yield relationships between iron exposure and functional outcomes. Methods: The following study retrospectively evaluated 41 patient serum samples obtained 1 day and 7 days post-ictus for CD163, ferritin, and hepcidin concentrations. Functional outcomes, using the modified Rankin Scale, were dichotomized into good (0-3) and poor (4-6). Correlation analysis and logistic regression were used to explore relationships between biomarker values, clinical metrics (such as ICH Score), and functional outcomes at 3 and 12 months. Results: Clinical metrics (Acute Physiology and Chronic Health Evaluation II score, ICH Score, and National Institutes of Health Stroke Scale) were correlated with elevated ferritin levels 7 days postictus. Furthermore, it was found that mean CD163 levels on day 1 were significantly associated with functional outcomes at 3 and 12 months; mean serum ferritin concentrations on days 1 and 7 were elevated in those with poor outcomes at 3 months, and day 7 levels were independently correlated with 12-month outcomes. Conclusion: Although this study serves to contribute to a growing body of evidence that CD163 and ferritin are biomarkers of functional outcomes, prospective cohort studies may clarify the role of iron-related inflammatory biomarkers as they pertain to neurological decline in patients with ICH. (C) 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.