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Mortality prediction by serum melatonin levels of patients with spontaneous intracerebral hemorrhage

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Abstract

Objective

In one study, higher serum melatonin levels have been reported at diagnosis of spontaneous intracerebral hemorrhage (ICH) in non-surviving than in surviving patients. Now, we carried out this study with the aims to explore whether blood melatonin concentrations in the first 7 days of ICH are different in survivor and non-survivor patients and whether are useful in the prediction of mortality.

Methods

Six Spanish hospitals participated in this observational study of patients with severe supratentorial ICH (defining severe as Glasgow Coma Scale < 9). We determined serum melatonin levels during the first, fourth, and eighth day of severe ICH.

Results

Surviving (n = 64) compared to non-surviving (n = 53) patients showed lower serum melatonin levels during the first (p < 0.001), fourth (p < 0.001), and eighth day (p < 0.001) of severe ICH. We found in multiple logistic regression analysis an association between serum melatonin levels and 30-day mortality (odds ratio = 8.932; 95% CI = 2.442–32.665; p = 0.001) controlling for midline shift, ICH score, early evacuation of ICH, and glycemia. We found an AUC (95% CI) for the mortality prediction of 0.90 (0.83–0.95; p < 0.001), 0.94 (0.87–0.98; p < 0.001), and 0.90 (0.81–0.96; p < 0.001) by serum melatonin concentrations during the first, fourth, and eighth day.

Conclusions

In our current study, it appears that novel findings of serum melatonin levels recollected at any moment during the first 7 days of a severe ICH were higher in non-survivor than in survivor patients and could help in mortality prediction.

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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

ICH:

Intracerebral hemorrhage

ICU:

Intensive care unit

INR:

International normalized ratio

PaO2 :

Pressure of arterial oxygen

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Acknowledgements

This study was supported by a grant from the 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.

Key messages

- Serum melatonin levels during the first week of a ICH were higher in non-surviving than in surviving patients.

- Serum melatonin levels during the first week of a ICH could predict early mortality.

Funding

This study was supported by a grant from the Instituto de Salud Carlos III (PI-18–00500) (Madrid, Spain) and co-financed with the Fondo Europeo de Desarrollo Regional (FEDER).

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. Deparment of Physiology, Faculty of Medicine, University of the La Laguna, Ofra s/n, La Laguna, 38320, Santa Cruz de Tenerife, Spain

    Pedro Abreu-González

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

    Luis Ramos-Gómez

  5. Intensive Care Unit, Hospital Clínico Universitario de Valencia, Avda. Blasco Ibáñez nº17-19, 46004, Valencia, Spain

    Mónica Argueso

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

    Juan J. Cáceres

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

    Alejandro Jiménez

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  1. Leonardo Lorente
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  2. María M. Martín
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  5. Mónica Argueso
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  6. Jordi Solé-Violán
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  7. Juan J. Cáceres
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  8. Alejandro Jiménez
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Contributions

LL was responsible of conceiving, designing, and coordinating the study and made substantial contributions to acquisition of data, analysis and interpretation of data, and drafted the manuscript. MMM, LRG, MA, JSV, and JJC have made substantial contributions to the acquisition of data and provided useful suggestions. PAG carried out blood determination levels. AJ have made substantial contributions to the 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.

Ethics declarations

Ethics approval and consent to participate

The protocol was approved by review board of the six hospitals participating in the study: H. Universitario Nuestra Señora de Candelaria (Santa Cruz de Tenerife), H. Clínico Universitario de Valencia, H. Insular de Las Palmas de Gran Canaria, H. General de La Palma, H. Universitario Dr. Negrín (Las Palmas de Gran Canaria), and H. Universitario de Canarias (San Cristóbal de La Laguna).

Consent for publication

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

Competing interests

The authors declare no competing interests.

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Lorente, L., Martín, M.M., Abreu-González, P. et al. Mortality prediction by serum melatonin levels of patients with spontaneous intracerebral hemorrhage. Neurol Sci 43, 1859–1864 (2022). https://doi.org/10.1007/s10072-021-05386-w

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  • DOI: https://doi.org/10.1007/s10072-021-05386-w

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