Association of Haptoglobin Phenotypes with Outcomes in Patients with Spontaneous Intracerebral Hemorrhage.
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ABSTRACT: Object
We aimed to investigate the association of Haptoglobin (Hp) phenotypes with perihematomal edema (PHE) and neurological outcomes after intracerebral hemorrhage (ICH).Methods
This prospective multicenter study enrolled patients that suffered ICH from March 2017 to February 2020. Hp phenotypes were determined using Western blotting; relative α1 intensity was calculated in patients with Hp2-1. A multivariable logistic regression analysis was then conducted to identify risk factors for increased relative PHE at 96 h and 3-month poor outcomes.Results
In total, 120 patients were ultimately enrolled: Hp1-1 (n = 15, 12.5%); Hp2-1 (n = 51, 42.5%); and Hp2-2 (n = 54, 45.0%). Hp phenotype was significantly associated with PHE (p = 0.028). With Hp1-1 as a reference value, Hp2-2 significantly increased the likelihood of increased rPHE (OR = 6.294, 95% CI: 1.283-30.881), while Hp2-1 did not (OR = 2.843, 95% CI: 0.566-14.284). Poor outcomes were found to be closely associated with hematoma volume at admission (OR = 1.057, 95% CI: 1.015-1.101) and surgical treatment (OR = 5.340, 95% CI: 1.665-17.122) but not Hp phenotypes (p = 0.190). Further, a high level of relative α1 intensity was identified to be significantly associated with decreased rPHE (OR = 0.020, 95% CI: 0.001-0.358). However, the relative α1 intensity was not associated with poor outcomes (OR = 0.057, 95% CI: 0.001-11.790).Conclusions
ICH patients with Hp2-2 exhibited a higher likelihood of increased rPHE than those with Hp1-1. Higher relative α1 intensities were identified to be closely associated with rPHE in patients with Hp2-1.
SUBMITTER: Jeon JP
PROVIDER: S-EPMC9318044 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Purpose of reviewSpontaneous intracerebral hemorrhage (ICH) is the deadliest stroke subtype. Acute treatments necessitate rapid hemorrhage control to minimize secondary brain injury. Here, we discuss the overlap of transfusion medicine and acute ICH care relating to diagnostic testing and therapies relevant for coagulopathy reversal and secondary brain injury prevention.Recent findingsHematoma expansion (HE) is the largest contributor to poor outcomes after ICH. Conventional coagulation assays to diagnose coagulopathy after ICH does not predict HE. Given the testing limitations, empiric pragmatic hemorrhage control therapies have been trialed but have not improved ICH outcomes, with some therapies even causing harm. It is still unknown whether faster administration of these therapies will improve outcomes. Alternative coagulation tests (e.g., viscoelastic hemostatic assays, amongst others) may identify coagulopathies relevant for HE, currently not diagnosed using conventional assays. This provides opportunities for rapid, targeted therapies. In parallel, ongoing work is investigating alternative treatments using transfusion-based or transfusion-sparing pharmacotherapies that can be implemented in hemorrhage control strategies after ICH.SummaryFurther work is needed to identify improved laboratory diagnostic approaches and transfusion medicine treatment strategies to prevent HE and optimize hemorrhage control in ICH patients, who appear particularly vulnerable to the impacts of transfusion medicine practices.
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Project description:Background: Intracerebral hemorrhage (ICH) is a highly lethal disease without effective therapeutic interventions. Anemia is prevalent in neurocritical disease and correlated with higher mortality in the intensive care unit. However, there is a lack of evidence concerning the association between anemia and the clinical outcomes of ICH. Object: We aimed to assess the association between anemia and outcomes in patients with ICH. Methods: We systematically searched the Cochrane Library, MEDLINE, EMBASE and Web of Science from inception to November 2017. Eligible studies were cohort studies exploring the association between anemia and mortality or functional outcomes in patient with ICH. A Meta-analysis was performed, and heterogeneity was assessed using the I2 index. Sensitivity analyses were performed to account for heterogeneity and risk of bias. Effect estimates were combined using random effects model for mortality and poor outcomes. Results: We identified seven cohort studies with 7,328 ICH patients, including 1,546 patients with anemia. The meta-analysis revealed that anemia was associated with higher mortality {OR = 1.72 for 30-day mortality (95% CI 1.37 to 2.15; I2 = 64%; low-quality evidence); OR = 2.05 for 12-month mortality (95% CI 1.42 to 2.97; I2 = 82%; low-quality evidence)} and an increased risk of poor outcome in patients with ICH {OR = 2.29 for 3-month outcome (95% CI 1.16 to 4.51; I2 = 91%; very low-quality evidence); OR = 3.42 for 12-month outcome (95% CI 0.50 to 23.23; I2 = 96%; very low-quality evidence)}. Conclusions: Anemia on admission was associated with higher mortality and an increased risk of poor outcome in patients with ICH. However, the results were limited by the high heterogeneity of included studies. Prospective, multi-center or population-based, large sample cohort studies are needed in the future.
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