Iron-related brain damage in patients with intracerebral hemorrhage.
OBJECTIVE
Iron plays a detrimental role after experimental intracerebral hemorrhage (ICH). This study investigates whether high-serum ferritin levels are associated with poor outcome in patients with ICH.


METHODS
We studied 92 consecutive patients with primary hemispheric ICH within the first 12 hours from onset of symptoms (median, 3.3 hours). National Institute of Health Stroke Scale score, ICH, and peripheral edema volumes were measured at admission, 72 hours, and 7 days. Serum levels of ferritin and biomarkers of the inflammatory response were determined. The adjusted effect of ferritin on the full range of Rankin scale was analyzed by a general linear model.


RESULTS
Fifty-one patients (55.4%) had poor outcome (Rankin score >2). Older age, higher stroke severity, larger hematoma volume, intraventricular extension, mass effect, and higher IL-6 and ferritin levels at baseline (270.6 [SD 81.4] vs 74.6 [SD 43.4] ng/mL; P<0.001) were associated with poor outcome. The higher the ferritin quartile, the worse the Rankin score. For every ferritin quartile, the Rankin score increased by a mean of 1.4 points (95% CI, 1.04-1.69) after adjusting for prognostic variables. Ferritin levels remained stable for 72 hours and did not correlate with acute phase reactants.


CONCLUSIONS
High-serum ferritin levels at admission are independently associated with poor outcome in patients with ICH. These findings may suggest a neurotoxic effect of increased body iron stores in patients with hemorrhagic stroke.
Pérez de la Ossa
Natalia
N
Sobrino
Tomás
T
Silva
Yolanda
Y
Blanco
Miguel
M
Millán
Monica
M
Gomis
Meritxell
M
Agulla
Jesús
J
Araya
Pablo
P
Reverté
Silvia
S
Serena
Joaquin
J
Dávalos
Antoni
A
D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001930:Brain Injuries / Q000175:diagnosis / Q000378:metabolism* / Q000473:pathology; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000378:metabolism* / Q000473:pathology; D005293:Ferritins / Q000097:blood*; D006801:Humans; D007501:Iron / Q000378:metabolism*; D008297:Male; D011379:Prognosis; D011446:Prospective Studies
D015415:Biomarkers; D005293:Ferritins; D007501:Iron