Role of Blood Based Biomarkers for Predicting Outcome after Spontaneous Intracerebral Hemorrhage: Multi-Centric Prospective Cohort Study

Objective: To determine whether blood based biomarkers within 48 hours of onset of stroke are significant predictor of 90-day mortality in patients with spontaneous Intracerebral hemorrhage (sICH). Background: Prediction of mortality after spontaneous sICH, is important for prognostication and shared clinical decision-making. Biomarkers may help in accurate prediction of mortality. Design/Methods: In a prospective multi-centric cohort study, patients with CT- proven ‘ICH’ were recruited within 48 hours of onset of symptoms. Venous blood samples (5 ml) were collected, serum levels of Troponin, Copeptin, C-reactive protein, GFAP (glial fibrillary acidic protein) and S100B were determined using method of Enzyme Linked Immunosorbent Assay (ELISA) by laboratory personnel masked for other clinical data. All the patients were telephonically followed using the modified Rankin Scale (mRS) at 3 months by an observer masked to the baseline and other clinical data. Study protocol has been published in BMC Neurology. Univariable and multivariable analyses were done to determine ‘discrimination’ of the predictive model using area under receiver operating curve (AUROC). All the statistical analyses were performed in STATA software (Version 13.1). Results: Data of 293 patients within 48 hours of onset of sICH were analysed. The mean age of patients was 56.57±13.86. AUROC for 90 day mortality were 0.58 (troponin), 0.53 (GFAP), 0.54 (Copeptin) and 0.54 (S100B). In multi-variable model with age, volume of sICH, intraventricular hemorrhage and Glassgow Coma Scale, only troponin contributed significantly (OR 2.57; 95% CI: 1.36 to 4.85, P = 0.003) with improved AUROC (0.73). Conclusions: Our findings suggest that S100B, GFAP and Copeptin do not significantly contribute to discrimination of prediction model. We found evidence in favour of troponin measured within 48 hours of onset as a significant contributor to discrimination of the model to predict 90 day mortality after sICH. Study Supported by: Study Supported by Department of Biotechnology, Government of India. Disclosure: Dr. Prasad has nothing to disclose. Dr. Kumar has nothing to disclose. Dr Misra has nothing to disclose. Dr. Sagar has nothing to disclose. Dr. Kaul has nothing to disclose. Dr. Dabla has nothing to disclose. Dr. Gorthi has nothing to disclose. Dr. Agrawal has nothing to disclose. Dr. Garg has nothing to disclose. Dr. Anand has nothing to disclose. Dr. Kaushik has nothing to disclose.