ANALYSIS OF INFORMATIVENESS OF SERUM FERRITIN CONCENTRATION IN DETERMINATION OF SPONTANEOUS SUPRATORIAL INTRACEREBRAL HAEMORRHAGE ACUTE PERIOD COURSE AND OUTCOME PROGNOSIS

Abstract

The aim  – to evaluate the informativeness of serum ferritin concentration in determination of individual risk of early clinical neurological deterioration and acute period outcome prognosis of spontaneous supratentorial intracerebral hemorrhage (SSIСH) on the ground of conservative therapy.

Material and Methods. Prospective cohort comparative study of 88 patients in the acute period of SSIH on the ground of conservative treatment was performed. Neurological deficit evaluation was made by using Full Outline of Unresponsiveness scale and National Institute of Health Stroke Scale (NIHSS). Brain structures visualization was made by computed tomography. During 24h hours from admission serum ferritin and iron levels, total iron-binding capacity and transferrin saturation ratio calculation was done. Early neurological deterioration (END) and unfavorable acute period SSIСH outcome as grading 4-6 scores by modified Rankine scale on the 21st day of the disease were chosen as clinical combined end points. Statistical processing was performed with logistic regression analysis, ROC-analysis and correlation analysis.

Results. The patients with unfavorable variants of SSIСH acute period course and outcome were characterized with higher serum ferritin level in the 1^st day from admission, thus that parameter was directly associated with brain structures injury severity. It was detected that evaluation of serum ferritin levels together with neurovisualization parameters (severity of midline shift, secondary intraventricular hemorrhage volume) as part of elaborated multipredictive logistic regression model gives the opportunity to predict END with high accuracy 89,8 % (AUC±SE [95 % CI] = 0,94±0,03 [0,86–0,98], р<0,0001). A highly sensitive multipredictive logistic regression model was also developed that incorporated prognostic value of serum ferritin concentration with clinical and neurovisualization parameters (NIHSS score, secondary intraventricular hemorrhage volume). It helps to identify individual risk of unfavorable acute period SSIСH outcome on the ground of conservative management with accuracy 87,5 % (AUC±SE [95 % CI] = 0,95±0,02 [0,89–0,99], р<0,0001).

Conclusions. Serum ferritin concentration in patients with SSICH is an informative additional parameter for short-term prognosis verification on the background of conservative therapy.