Evaluation of Serum Ferritin as a Prognostic Marker in Acute Hemorrhagic Stroke

Abstract

Background Acute hemorrhagic stroke (AHS) resulting from intracerebral hemorrhage (ICH) is a rampant neurological disorder with devastating consequences, particularly in Indians. Recently, serum ferritin levels have been related to adverse cardiovascular and stroke outcomes. We aimed to evaluate the prognostic utility of serum ferritin in AHS. Materials and Methods Admission serum ferritin levels were estimated in 50 AHS patients with primary supratentorial hemorrhage. Study subjects were categorized based on their prognostic scores in modified Rankin scale (mRS) assessment. Ferritin levels were compared across the study groups, correlated with mRS and other ICH severity indicators. Results Serum ferritin and other ICH severity indices such as Glasgow coma scale (GCS) and ICH volume were significantly altered in the mRS groups by the end of 7th and 30th days of hospitalization. Elevated ferritin levels, ICH volume together with decreased GCS, characterized the groups with adverse prognosis. Serum ferritin moderately correlated with GCS (r = –0.643), ICH volume (r = 0.562), and had significantly higher correlations with long-term prognostic scores of 7th day mRS (r = 0.802) and 30th day mRS (r = 0.916). Conclusion Elevated admission serum ferritin levels indicate poor AHS short-term and long-term outcomes, thereby making serum ferritin a possible prognostic index for the same.

Protein Carbonylation Contributes to Prothrombotic Fibrin Clot Phenotype in Acute Ischemic Stroke: Clinical Associations

“…22,46 Similarly, an independent association of high admission serum ferritin levels with unfavorable outcomes has been found in patients with intracerebral hemorrhage. 47,48 In our study, the iron overload status was more pronounced in nonsurvivors, but it was not associated with hemorrhagic transformation or disability. Transferrin levels were lower in untreated patients most likely due to the longer time from the symptom onset.…”

Association between circulating inflammatory biomarkers and functional outcome or perihaematomal oedema after ICH: a systematic review & meta-analysis

“…From three studies reporting on ferritin and clinical outcome 29 , 32 , 105 , two studies of 155 participants measuring ferritin upon admission were included in a meta-analysis 29 , 32 . Neither of these studies included a multivariable analysis.…”

Ferritin and Neurotoxicity: A Contributor to Deleterious Outcomes for Subarachnoid Hemorrhage

“…In recent years, research has continued to reveal an association between elevated ferritin and various neuropathologies, such as neurovascular, neurodegenerative, and neuroautoimmune diseases [12,[30][31][32]. In such diseases, ferritin may become overwhelmed and no longer able to maintain proper homeostasis within the brain [27].…”

“…Preclinical studies have shown a vasoconstrictive effect from iron-containing hemin, and Gomes et al [34] performed a pilot study showing that levels of nonprotein-bound iron were significantly higher in patients who developed vasospasm after aneurysmal SAH [62]. A recent study by Rajendran et al [30] used serum ferritin as a prognostic marker in acute hemorrhagic stroke and found that elevated ferritin on admission indicated poor short-term and long-term outcomes using a modified Rankin scale, an extensive stroke scoring system. Therefore, CNS pathology is likely not due to iron overload, and the ferritin aggregates likely independently lead to significant disease manifestations.…”