Emergency department point-of-care biomarkers and day 90 functional outcome in spontaneous intracerebral hemorrhage: A single-center pilot study

Abstract

Spontaneous intracerebral hemorrhage (sICH) results in high morbidity and mortality rates, thus identifying strategies for timely prognosis and treatment is important. The present study aimed to analyze the relationship between emergency department point-of-care (POC) blood biomarkers and day 90 functional outcome (FO) in patients with acute (<8 h) sICH. On-site POC determinations, including complete blood count, glucose, cardiac troponin I, D-dimer and C-reactive protein, and derived inflammatory indexes were performed for a cohort of 35 patients. The primary endpoint was a favorable day 90 FO (modified Rankin Score ≤3). Secondary endpoints included early neurological worsening (ENW), day 7/discharge neurological impairment, day 90 independence assessment (Barthel Index <60), hematoma enlargement and perihematomal edema (PHE) growth. A favorable three-month FO was reported in 16 (46%) participants. Older age, previous history of ischemic stroke and initial imagistic parameters, including intraventricular hemorrhage, enlarged contralateral ventricle and cerebral atrophy, significantly predicted an unfavorable FO. The admission D-dimer similarly predicted day 90 FO and the independence status, along with ENW and a more severe day 7/discharge neurological status. The D-dimer also correlated with the initial neurological status and PHE. PHE growth correlated with granulocytes, systemic immune-inflammation index and glycemia. The results suggested that a lower admission D-dimer could indicate an improved day 90 FO of patients with sICH, while also anticipating the development of PHE growth and ENW.

Keywords: D-dimer; biomarkers; emergency department; functional outcome; point-of-care testing; spontaneous intracerebral hemorrhage.

Figure 1

Routine ED baseline assessment of patients with sICH and study specific interventions. ED, emergency department; SpO₂, peripheral oxygen saturation; RR, respiratory rate; HR, heart rate; BP, blood pressure; ECG, electrocardiogram; GCS, Glasgow Coma Scale score; POC, point-of-care; ABG, arterial blood gases; CBC, complete blood count; WBC, white blood cells; GRA, granulocytes; LYM, lymphocytes; MID, mid-cell population; PLT, platelets; RBC, red blood cells; Hb, hemoglobin; RDW, red cell distribution width; APTT, activated partial prothrombin time; PT, prothrombin time; INR, international normalized ratio; IP/PT, prothrombin index/prothrombin time; CT, computer tomography; sICH, spontaneous intracerebral hemorrhage; NIHSS, National Institute of Health Stroke Scale; cTnI, cardiac troponin I; hs-CRP, high-sensitive C reactive protein.

Figure 2

Receiver operation characteristic curve of admission D-dimer predicting day 90 functional outcome. Cut-off, 0.905 µg/ml fibrinogen equivalent units. AUC, area under curve.