Lower Ionized Calcium Predicts Hematoma Expansion and Poor Outcome in Patients with Hypertensive Intracerebral Hemorrhage

Zhang, Yibin; Zheng, Shu-Fa; Yao, Pei-Sen; Chen, Guorong; Li, Guanghai; Li, Song-Chuan; Yong, Zheng; Wang, Jianqun; Kang, Dezhi; Shang-Guan, Huang-Cheng

doi:10.1016/j.wneu.2018.06.223

Cited by 20 publications

(18 citation statements)

References 24 publications

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“…Follow-up CT was carried out within 24 h after hospital admission to identify a HE diagnosis. ICH volumes were calculated using a post-processing workstation (Advantage Workstation 4.6, GE Healthcare, Chicago, Illinois, USA) ( 30 ). HE was defined as a 33% increase in the hematoma volume or >6 mL on follow-up imaging ( 31 ).…”

Section: Methodsmentioning

confidence: 99%

Association Between Partial Pressure of Carbon Dioxide and Immediate Seizures in Patients With Primary Intracerebral Hemorrhage: A Propensity-Matched Analysis

Pan¹,

Zhong

Wang³

et al. 2022

Front. Neurol.

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PurposeTo explore the value of partial pressure of carbon dioxide (PaCO2) levels in arterial blood for predicting immediate seizures (ISs) in patients with primary intracerebral hemorrhage (ICH).MethodsDemographic information and clinical data from patients with primary ICH were prospectively collected, including arterial blood gas analysis. Immediate seizures (ISs) were determined as seizures in the first 24 h after admission. Univariate and multivariate analyses were performed to assess the association of PaCO2 levels with ISs. Propensity-score matching (PSM) analyses were adopted to reduce the baseline difference between ISs and non-ISs groups.ResultsA total of 596 patients with primary ICH were initially screened in this clinical study, 368 of whom fulfilled all the inclusion criteria [mean age, (60.46 ±12.78) years; 57.9% female patients]. ISs occurred in 30 of the 368 (8.15%) patients with primary ICH of this cohort. Patients with ISs had significantly lower PaCO2 levels [34.35(32.38–37.53) vs. 39.45(35.90–43.43), mmHg, p < 0.001] and were younger than those without ISs [(54.57±12.15 vs. 60.99 ±12.72) years, p = 0.008]. Multivariate analysis showed that lower initial PaCO2 (≤37.2 mmHg) level was a significant independent predictor of ISs [odds ratios (OR) 0.141, 95% confidence interval (CI) 0.057–0.351, p < 0.001], as well as younger age (OR 0.961, 95% CI 0.928–0.995, p = 0.023) and hematoma expansion (OR 0.340, 95% CI 0.134–0.863, p = 0.023). Receiver operating characteristic curve (ROC) analysis demonstrated that the optimal cutoff value of PaCO2 level for predicting ISs was 37.20 mmHg in patients with primary ICH (the area under the curve (AUC) was 0.760 with a corresponding sensitivity of 76.67% and specificity of 67.46%, 95%CI = 0.713–0.802, p < 0.001). After PSM, the matched ISs group had significantly lower PaCO2 levels compared with the matched non-ISs group [34.45(32.43–38.18) vs. 41.75(35.85–43.98) mmHg, p < 0.05] in the univariate analysis. The lower initial PaCO2 level was still independent of ISs following primary ICH.ConclusionsThe lower initial PaCO2 level was associated with an increased risk of ISs in patients with primary ICH.

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Section: Methodsmentioning

confidence: 99%

Association Between Partial Pressure of Carbon Dioxide and Immediate Seizures in Patients With Primary Intracerebral Hemorrhage: A Propensity-Matched Analysis

Pan¹,

Zhong

Wang³

et al. 2022

Front. Neurol.

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“…Hematoma expansion then transitions into the secondary peri-hematomal edema (PHE) 14 , 15 phase where brain tissue reacts to acute hematoma development, and local extravascular blood products and peripheral expansion trigger an inflammatory response to disintegrate the hematoma ( Figures 1 and 2 ). Vasogenic edema results due to increased extravasated fluid accumulation due to BBB disruption of endothelial tight junctions.…”

Section: Secondary Mechanisms Of Ich Triggering Systemic Inflammatory Responsesmentioning

confidence: 99%

“…Beyond being a single event, hematoma formation and expansion appear to be accompanied by complex inflammatory and vascular processes 12,13 (Figure 1) characterized by an "avalanche model" where ruptured vessels at the hematoma periphery propagate mechanical shearing of neighboring vessels and lead to hematoma expansion via both microbleeds and large vessel hemorrhage. 6,12,13 Hematoma expansion then transitions into the secondary peri-hematomal edema (PHE) 14,15 phase where brain tissue reacts to acute hematoma development, and local extravascular blood products and peripheral expansion trigger an inflammatory response to disintegrate the hematoma (Figures 1 and 2). Vasogenic edema results due to increased extravasated fluid accumulation due to BBB disruption of endothelial tight junctions.…”

Section: Secondary Mechanisms Of Ich Triggering Systemic Inflammatory...mentioning

confidence: 99%

“…[26][27][28] Serum calcium is normally found ionized and charged (active physiological form), in a free state and protein bound, or as an anion bound complex. 14,15 Calcium is regulated by parathyroid hormone, vitamin D metabolites, and calcitonin. 14,[28][29][30] Calcium has numerous potential roles in ICH.…”

Section: Calcium and Pth As Pre-existing Conditions Impacting Ich Pro...mentioning

confidence: 99%

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Secondary mechanisms of injury and viable pathophysiological targets in intracerebral hemorrhage

Bautista

Adelson

Bicher

et al. 2021

Ther Adv Neurol Disord

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Intracerebral hemorrhage (ICH) can be divided into a primary and secondary phase. In the primary phase, hematoma volume is evaluated and therapies are focused on reducing hematoma expansion. In the secondary, neuroprotective phase, complex systemic inflammatory cascades, direct cellular toxicity, and blood-brain barrier disruption can result in worsening perihematomal edema that can adversely affect functional outcome. To date, all major randomized phase 3 trials for ICH have targeted primary phase hematoma volume and incorporated clot evacuation, intensive blood pressure control, and hemostasis. Reasons for this lack of clinical efficacy in the major ICH trials may be due to the lack of therapeutics involving mitigation of secondary injury and inflexible trial design that favors unilateral mechanisms in a complex pathophysiology. Potential pathophysiological targets for attenuating secondary injury are highlighted in this review and include therapies increasing calcium, antagonizing microglial activation, maintaining macrophage M1 versus M2 balance by decreasing M1 signaling, aquaporin inhibition, NKCCl inhibition, endothelin receptor inhibition, Sur1-TRPM4 inhibition, matrix metalloproteinase inhibition, and sphingosine-1-phosphate receptor modulation. Future clinical trials in ICH focusing on secondary phase injury and, potentially implementing adaptive trial design approaches with multifocal targets, may improve insight into these mechanisms and provide potential therapies that may improve survival and functional outcome.

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“…In general, the treatment is mainly based on the age of patients and the characteristics of bleeding. However, the treatment principles are mainly to reduce intracranial pressure, clear hematoma and improve the prognosis of patients (19,(21)(22)(23). The purpose of this study is to analyze the effect of stereotactic soft channel puncture and drainage in the treatment of hypertensive cerebral hemorrhage.…”

Section: A B C Dmentioning

confidence: 99%

Observation on therapeutic effect of stereotactic soft channel puncture and drainage on hypertensive cerebral hemorrhage

Mao¹,

Zy²,

Zhu³

et al. 2020

Ann Palliat Med

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Background: To evaluate and analyze the therapeutic effect of stereotactic soft channel puncture and drainage on hypertensive cerebral hemorrhage.Methods: Sixty patients with hypertensive cerebral hemorrhage admitted to our hospital from September 2014 to September 2019 were selected for study and randomly divided into study group (n=30) and routine group (n=30) according to admission number. Two groups of patients were given basic treatment after admission, while routine group patients were given small bone window hematoma removal, study group patients were given stereotactic soft channel puncture and drainage, and the clinical effects of the two groups were analyzed. Results:The total effective rate of the study group was 96.67%, which was significantly higher than that of the routine group (80.00%), and the difference was statistically significant (P<0.05). The level of independent living in the study group was significantly higher than that in the conventional group, and the level of neurological deficit was lower than that in the conventional group, with statistically significant difference (P<0.05). Before treatment, there was no significant difference in the hematoma volume between the two groups (P>0.05). after treatment for 1, 2 and 4 weeks, the hematoma volume of the two groups decreased, and the hematoma volume of the study group was significantly less than that of the conventional group, with significant difference (P<0.05). There was no difference in CD3 + positive cell rate and CD8 + positive cell rate between the two groups before treatment (P>0.05). After treatment, the CD8 + positive cell rate in the study group was lower than that in the conventional group, and the CD3 + positive cell rate was higher than that in the conventional group, with statistically significant difference (P<0.05). The incidence of postoperative complications such as pulmonary infection, urinary tract infection, liver and kidney dysfunction in the study group was lower than that in the conventional group, and the difference was statistically significant (P<0.05).Conclusions: Stereotactic soft-channel puncture and drainage has the advantages of less trauma, less bleeding, fewer complications and rapid postoperative recovery. It can be used for the treatment of hypertensive cerebral hemorrhage, promote the recovery of neurological function of patients, improve independent living standard and effectively improve prognosis.

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Lower Ionized Calcium Predicts Hematoma Expansion and Poor Outcome in Patients with Hypertensive Intracerebral Hemorrhage

Cited by 20 publications

References 24 publications

Association Between Partial Pressure of Carbon Dioxide and Immediate Seizures in Patients With Primary Intracerebral Hemorrhage: A Propensity-Matched Analysis

Association Between Partial Pressure of Carbon Dioxide and Immediate Seizures in Patients With Primary Intracerebral Hemorrhage: A Propensity-Matched Analysis

Secondary mechanisms of injury and viable pathophysiological targets in intracerebral hemorrhage

Observation on therapeutic effect of stereotactic soft channel puncture and drainage on hypertensive cerebral hemorrhage

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