Prognostic Utility of Serum Biomarkers in Intracerebral Hemorrhage: A Systematic Review

Abstract

Background. Intracerebral hemorrhage (ICH) accounts for 10–20% of all strokes and is associated with high morbidity and mortality. Recent studies have identified serum biomarkers as a means to improve outcome prognostication in poor grade ICH patients. Poor prognosis of ICH patients and complex pathophysiology of the disease necessitate prognostic serum biomarkers to help guide treatment recommendations. Objective. The objective is to systematically review all biomarkers used to predict long-term functional outcome in patients with spontaneous intracerebral hemorrhage. Results. We identified 36 studies investigating the predictive utility of 50 discrete biomarkers. Data from 4865 ICH patients were reviewed. Inflammatory biomarkers (11/50) were most often studied, followed by oxidative (8/50), then neuron and astrocyte-specific (7/50). S100 calcium binding protein B, white blood cell count, and copeptin were the most often studied individual biomarkers. The prognostic utility of 23 biomarkers was analyzed using receiver operating characteristic curves. Area under the curve (AUC) values for all available biomarkers except neutrophil/lymphocyte ratio were acceptable. Twenty of the 23 biomarkers were characterized by at least one excellent AUC value. Vascular endothelial growth factor, glial fibrillary astrocyte protein, and S100 calcium binding protein B were characterized by outstanding AUC. Conclusions. We identified the inflammatory and neuron and astrocyte-specific biomarker categories as having the greatest number of significant individual biomarker predictors of long-term outcome. Further investigation utilizing cross-validation of prediction models in a second independent group and blinded assessment of outcomes for the predictive utility of biomarkers in patients with ICH is warranted.

Potential Biomarkers for Post-Stroke Cognitive Impairment: A Systematic Review and Meta-Analysis

“…Thus, biomarkers are beneficial for patients, caregivers, and clinicians for: (a) planning subsequent clinical pathways and goal setting; and (b) identifying whom and when to target and, in some instances, at which level to use, along with interventions for promoting stroke recovery [ 22 ]. The application of these biomarkers can improve risk stratification and therefore guide the implementation of tailored treatment modalities [ 23 ].…”

Prognostic Significance of the Combined Score of Plasma Fibrinogen and Neutrophil-Lymphocyte Ratio in Patients with Spontaneous Intracerebral Hemorrhage

“…Based on these facts, NLR was reported to be a prognostic indicator for patients with ischemic stroke, ICH, and subarachnoid hemorrhage and also predicted the presence of stroke-associated complications, suggesting that both ischemic and hemorrhagic stroke may share common pathways. [ 27 – 33 ] However, controversial results showed that although inflammatory biomarkers in the serum were widely studied to predict the outcome of ICH, NLR seems to be not well enough in the prediction [ 34 ].…”

Precision Medicine in Neurocritical Care for Cerebrovascular Disease Cases

“…Comprehensive lists of serum and cerebrospinal fluid biofluid markers studied in different subtypes of ischemic and hemorrhagic cerebrovascular diseases are reviewed elsewhere. [20][21][22] Successful translation of diagnostic, predictive, or prognostic biofluid markers in cerebrovascular disease, like all fields, requires discovery and standardization of methodologies, development of reliable assays, reasonable sensitivity/ specificity parameters, and outperformance of current clinical performance models. A few leading candidates have been highlighted in Table S1; however, there is no precise method to identify those most likely to translate clinically.…”