Abstract
Association of a high-serum ferritin with poor outcome showed that iron might play a detrimental role in the brain after intracerebral hemorrhage (ICH). Here, we investigated changes in serum iron, ferritin, transferrin (Tf) and ceruloplasmin (CP) in patients with ICH (n = 100) at day 1 (admission), 3, 7, 14 and 21 and those in control subjects (n = 75). The hematoma and edema volumes were also determined in ICH-patients on admission and at day 3. The Modified Rankin Scale (mRS) of 59 patients was ≥3 (poor outcome) and 41 < 3 (good outcome) at day 90. Serum ferritin was significantly higher and serum iron and Tf markedly lower in patients with poor-outcome than the corresponding values in patients with good-outcome at day 1 to 7 and those in the controls. There was a significant positive correlation between serum ferritin and relative edema volume or ratio at day 1 and 3 and hematoma volume at day 1 (n = 28), and a negative correlation between serum iron or Tf and hematoma volume at day 1 (n = 100). We concluded that not only increased serum ferritin but also reduced serum iron and Tf are associated with outcome as well as hematoma volume.
Highlights
Coefficient to determine the association of these indicators of iron metabolism we measured with relative edema volume, relative edema ratio and hematoma volume as well as serum iron with ferritin, CP or Tf, and ferritin with Tf contents
Correlation analysis demonstrated that there were highly significant correlations between serum ferritin and relative edema volume as well as ratio in 28 patients with supratentorial Intracerebral hemorrhage (ICH) at day 1 and day 3 and between serum ferritin and hematoma volume in 100 patients at day 1. These findings were consistent with the results reported by other groups, providing further evidence that serum ferritin measured at day 3 to 4 after ICH were associated with relative perihematoma edema volume[8,13,14] and those on admission could predict clinical outcome in patients with ICH15,16
Based on the findings in this study plus the previous studies[15,16], we proposed that a combination of serum iron, ferritin and Tf is a reliable predictor of functional outcome in patients with ICH compared with ferritin only
Summary
A total of 100 consecutive patients with acute intracerebral hemorrhage (ICH) were enrolled in this study. All patients, aged 40–80 years old, were admitted to the Department of Neurosurgery, The First Affiliated Hospital of Third Military Medical University (Chongqing, China) within 24 h after stroke onset during the period from May 2014 and June 2015. All patients were admitted at an acute stroke unit and treated according to the guidelines of the European Stroke Initiative Writing Committee[31]. Patients with secondary causes of ICH, such as anticoagulant use, underlying aneurysm vascular malformation or tumor, head trauma, or hemorrhagic transformation of ischemic infarcts were excluded. Patients were excluded if they had an underlying medical disease that had an effect on the level of iron and ferritin such as anemia and severe liver or renal disease, intravenous drug abuse and pregnancy
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