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High serum levels of TAC and early mortality in patients with spontaneous intracerebral haemorrhage

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Abstract

Objective

Oxidation contributes to secondary brain injury after spontaneous intracerebral haemorrhage (SIH). One study found lower levels of total antioxidant capacity (TAC) in the blood in patients with SIH than in healthy subjects. However, there are no data on blood TAC levels and survival in patients with SIH. Therefore, the objective of our study was to determine if an association exists between serum TAC levels and mortality in patients with SIH.

Methods

We included patients with severe supratentorial SIH. We considered severe when Glasgow Coma Scale (GCS) < 9. Patients from 6 Spanish hospitals were included in this observational and prospective study. Serum TAC levels at days 1, 4 and 8 of SIH were determined. Thirty-day mortality was our end-point study.

Results

Non-surviving patients compared with surviving patients showed higher serum TAC levels at day 1 (p < 0.001), 4 (p < 0.001) and 8 (p = 0.001). An area under the curve was found for the prediction of 30-day mortality by serum TAC levels of 0.92 (95% CI = 0.85–96%; p < 0.001). Multiple logistic regression analysis showed an association of serum TAC levels with 30-day mortality (odds ratio = 16.513; 95% CI = 2.548–107.015; p = 0.003) controlling for midline shift, glycemia, early evacuation of SIH, intracerebral haemorrhage (ICH) score, age and volume of SIH.

Conclusions

The new findings of this study are that serum TAC levels are higher in non-surviving than in surviving patients, and that they are associated with mortality and could be used to predict mortality.

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Abbreviations

APACHE II:

Acute Physiology and Chronic Health Evaluation

aPTT:

activated partial thromboplastin time

FIO2 :

fraction inspired oxygen

GCS:

Glasgow Coma Scale

ICU:

intensive care unit

ICH:

intracerebral haemorrhage

INR:

international normalized ratio

PaO2 :

pressure of arterial oxygen

SIH:

spontaneous intracerebral haemorrhage

TAC:

total antioxidant capacity

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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). Fundings 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., 38320, La Laguna, 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

    MarĂ­a M. MartĂ­n

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

    Antonia Pérez-Cejas & Agustín F. González-Rivero

  4. Department of Radiology, Hospital Universitario de Canarias, Ofra, s/n., 38320, La Laguna, Santa Cruz de Tenerife, Spain

    Rafael Sabatel

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

    Luis Ramos-GĂłmez

  6. Intensive Care Unit, Hospital Clínico Universitario de Valencia, Avda. Blasco Ibáñez no. 17-19, 46004, Valencia, Spain

    MĂłnica Argueso

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

    Jordi Solé-Violán

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

    Juan J. Cáceres

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

    Alejandro Jiménez

  10. Department of Neurosurgery, Hospital Universitario de Canarias, Ofra, s/n., 38320, La Laguna, Santa Cruz de Tenerife, Spain

    Victor GarcĂ­a-MarĂ­n

Authors
  1. Leonardo Lorente
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  2. MarĂ­a M. MartĂ­n
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  3. Antonia PĂ©rez-Cejas
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  4. Agustín F. González-Rivero
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  5. Rafael Sabatel
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  6. Luis Ramos-GĂłmez
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  7. MĂłnica Argueso
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  8. Jordi Solé-Violán
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  9. Juan J. Cáceres
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  10. Alejandro Jiménez
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  11. Victor GarcĂ­a-MarĂ­n
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Contributions

LL was responsible of conceive, design and coordinate the study, made substantial contributions to acquisition of data, analysis and interpretation of data and drafted the manuscript. MMM, RS, LRG, MA, JSV JJC and VGM have made substantial contributions to acquisition of data and provided useful suggestions. APC and AFGR 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 six 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. Clínico Universitario de Valencia, 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.

Additional information

Key messages

• Serum TAC levels during the first week of SIH were higher in non-surviving patients

• High serum TAC levels at SIH diagnosis are associated with mortality

• Serum TAC levels at SIH diagnosis could be used to mortality prediction.

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Lorente, L., Martín, M.M., Pérez-Cejas, A. et al. High serum levels of TAC and early mortality in patients with spontaneous intracerebral haemorrhage. Neurol Sci 42, 1491–1497 (2021). https://doi.org/10.1007/s10072-020-04692-z

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  • DOI: https://doi.org/10.1007/s10072-020-04692-z

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