title: Biomarkers of Functional Outcome in Intracerebral Hemorrhage: Interplay between Clinical Metrics, CD163, and Ferritin.
abstract: BACKGROUND
  Intracerebral hemorrhage (ICH) is associated with neurological decline and poor prognosis. Although many etiologic models have been explored, secondary damage caused by continued inflammation and iron exposure from red blood cell lysis may explain poor outcomes at distant follow-up. Examining serum samples of patients with ICH for biomarkers of iron physiology may yield relationships between iron exposure and functional outcomes.
  
  
  METHODS
  The following study retrospectively evaluated 41 patient serum samples obtained 1 day and 7 days post-ictus for CD163, ferritin, and hepcidin concentrations. Functional outcomes, using the modified Rankin Scale, were dichotomized into good (0-3) and poor (4-6). Correlation analysis and logistic regression were used to explore relationships between biomarker values, clinical metrics (such as ICH Score), and functional outcomes at 3 and 12 months.
  
  
  RESULTS
  Clinical metrics (Acute Physiology and Chronic Health Evaluation II score, ICH Score, and National Institutes of Health Stroke Scale) were correlated with elevated ferritin levels 7 days post-ictus. Furthermore, it was found that mean CD163 levels on day 1 were significantly associated with functional outcomes at 3 and 12 months; mean serum ferritin concentrations on days 1 and 7 were elevated in those with poor outcomes at 3 months, and day 7 levels were independently correlated with 12-month outcomes.
  
  
  CONCLUSIONS
  Although this study serves to contribute to a growing body of evidence that CD163 and ferritin are biomarkers of functional outcomes, prospective cohort studies may clarify the role of iron-related inflammatory biomarkers as they pertain to neurological decline in patients with ICH.
authors.affiliation: College of Physicians and Surgeons, Columbia University, New York, New York. Electronic address: andrew.garton@columbia.edu.
authors.forename: Andrew L A
authors.initials: ALA
authors.lastname: Garton
authors.affiliation: College of Physicians and Surgeons, Columbia University, New York, New York.
authors.forename: Vivek P
authors.initials: VP
authors.lastname: Gupta
authors.affiliation: Department of Neurosurgery, College of Physicians and Surgeons, Columbia University, New York, New York.
authors.forename: Brandon R
authors.initials: BR
authors.lastname: Christophe
authors.affiliation: Department of Neurosurgery, College of Physicians and Surgeons, Columbia University, New York, New York.
authors.forename: E Sander
authors.initials: ES
authors.lastname: Connolly
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D015703:Antigens, CD / Q000097:blood*; D015214:Antigens, Differentiation, Myelomonocytic / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002543:Cerebral Hemorrhage / Q000097:blood* / Q000175:diagnosis / Q000503:physiopathology; D004185:Disability Evaluation; D005260:Female; D005293:Ferritins / Q000097:blood*; D064451:Hepcidins / Q000097:blood; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011956:Receptors, Cell Surface / Q000097:blood*; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors; D000098902:CD163 Antigen
chemical_list: D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; D015415:Biomarkers; D000098902:CD163 Antigen; D064451:Hepcidins; D011956:Receptors, Cell Surface; D005293:Ferritins
keywords: Biomarkers; functional outcome; intracerebral hemorrhage; iron regulation