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Serum B cell lymphoma-2 concentrations and mortality of patients with spontaneous intracerebral hemorrhage

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Abstract

Objective

There is scarce data on B cell lymphoma 2 (Bcl2), a member of the Bcl-2 family of antiapoptotic molecules of the intrinsic apoptosis pathway, in patients with spontaneous intracerebral hemorrhage (SIH). In one study, higher serum Bcl2 levels were found in patients with SIH than in healthy subjects. Thus, the objective of our study was to compare serum Bcl2 levels in surviving and non-surviving SIH patients.

Methods

Patients with severe supratentorial SIH (defined as Glasgow Coma Scale < 9) admitted from the Intensive Care Units of five Spanish hospitals were included in this observational and prospective study. Serum levels of Bcl2L were determined at the time of diagnosis. Thirty-day mortality was the end-point study.

Results

Non-surviving (n = 38) compared to surviving patients (n = 41) had higher intracerebral hemorrhage (ICH) score (p = 0.001), midline shift (p = 0.003), and serum Bcl2 levels (p < 0.001). In addition, non-surviving compared to surviving patients had lower early hematoma evacuation rate (p = 0.03). We found 77% area under curve in mortality prediction for serum Bcl2 levels (95% CI = 0.66–88%; p < 0.001). Patients showing serum Bcl2 levels > 16.5 ng/mL had higher risk of death according to analysis of Kaplan-Meier (HR = 5.2; 95% CI = 2.5–10.6; p < 0.001). An association, after control for ICH score, midline shift, and early hematoma evacuation, was found between serum Bcl2 levels and 30-day mortality (OR = 1.090; 95% CI = 1.030–1.154; p = 0.003) in the multiple logistic regression.

Conclusions

As far as we know, our study is the first one reporting higher serum Bcl2 levels in non-surviving than in surviving SIH patients and the association between serum Bcl2 levels and SIH mortality.

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Abbreviations

APACHE-II:

Acute Physiology and Chronic Health Evaluation

aPTT:

Activated partial thromboplastin time

FIO2 :

Fraction inspired of oxygen

GCS:

Glasgow Coma Scale

ICU:

Intensive Care Unit

INR:

International normalized ratio

ISS:

Injury Severity Score

PaO2 :

Pressure of arterial oxygen

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Funding

This study was supported by a grant from Instituto de Salud Carlos III (PI-18-00500) (Madrid, Spain) and co-financed with Fondo Europeo de Desarrollo Regional (FEDER). The funding did not influence in the study design, the collection, analysis, and interpretation of data, the manuscript writing, and the decision to submit it for publication.

Author information

Authors and Affiliations

  1. Intensive Care Unit, Hospital Universitario de Canarias, Ofra s/n, La Laguna, 38320, Santa Cruz de Tenerife, Spain

    Leonardo Lorente

  2. Intensive Care Unit, Hospital Universitario Nuestra Señora de Candelaria, Crta del Rosario s/n, 38010, Santa Cruz de Tenerife, Spain

    María M. Martín

  3. Laboratory Department, Hospital Universitario de Canarias, Ofra, s/n, La Laguna, 38320, Santa Cruz de Tenerife, Spain

    Agustín F. González-Rivero, Antonia Pérez-Cejas & Jacobo J. Villacampa-Jiménez

  4. Intensive Care Unit, Hospital General La Palma, Buenavista de Arriba s/n, La Palma, 38713, Breña Alta, Spain

    Luis Ramos-Gómez

  5. Intensive Care Unit, Hospital Insular, Plaza Dr. Pasteur s/n, 35016, Las Palmas de Gran Canaria, Spain

    Juan J. Cáceres

  6. Intensive Care Unit, Hospital Universitario Dr. Negrín, CIBERES, Barranco de la Ballena s/n, 35010, Las Palmas de Gran Canaria, Spain

    Jordi Solé-Violán

  7. Research Unit, Hospital Universitario de Canarias, Ofra s/n, La Laguna, 38320, Santa Cruz de Tenerife, Spain

    Alejandro Jiménez

Authors
  1. Leonardo Lorente
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  2. María M. Martín
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  3. Agustín F. González-Rivero
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  8. Jacobo J. Villacampa-Jiménez
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  9. Alejandro Jiménez
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Contributions

LL was responsible for conceiving, designing, and coordinating the study, made substantial contributions to acquisition of data, analysis, and interpretation of data, and drafted the manuscript.

MMM, LRG, JSV, and JJC have made substantial contributions to acquisition of data and provided useful suggestions.

APC, AFGR, and JJVJ participated in blood determination levels.

AJ have made substantial contributions to analysis and interpretation of data.

All authors read critically and approved the manuscript, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Leonardo Lorente.

Ethics declarations

Competing interests

The authors declare that they have no competing interests.

Ethical approval

The protocol was approved by Review Board of the five hospitals participating in the study: H. Universitario Dr. Negrín (Las Palmas de Gran Canaria), H. Universitario Nuestra Señora de Candelaria (Santa Cruz de Tenerife), H. Insular de Las Palmas de Gran Canaria, H. General de La Palma, and H. Universitario de Canarias (La Laguna).

Informed consent

The written signed informed consent was obtained by a family member of each patient.

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Key messages

• Non-surviving at 30 days showed higher serum Bcl2 levels than surviving patients.

• There is an association between serum Bcl2 levels and mortality.

• Serum Bcl2 levels could be used as prognostic biomarker mortality.

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Lorente, L., Martín, M.M., González-Rivero, A.F. et al. Serum B cell lymphoma-2 concentrations and mortality of patients with spontaneous intracerebral hemorrhage. Neurol Sci 42, 3631–3636 (2021). https://doi.org/10.1007/s10072-021-05048-x

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  • DOI: https://doi.org/10.1007/s10072-021-05048-x

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