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Minerva Medica 2020 Jul 20

DOI: 10.23736/S0026-4806.20.06685-9

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

Correlations of inflammatory factors, CCCK-18, MMP-9 and D-Dimer with APACHE II score and prognosis of patients with acute cerebral hemorrhage

Feng WE 1, Yan CUI 2 , Xiuhua GUO 2, Guoping DONG 2, Xiulong LI 1

1 Department of Neurosurgery, Caoxian People's Hospital, Heze, China; 2 Department of Neurology, Caoxian People's Hospital, Heze, China


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BACKGROUND: To explore the correlations of inflammatory factors, caspase-cleaved cytokeratin-18 (CCCK-18), matrix metalloproteinase-9 (MMP-9) and D-Dimer (DD) with the acute physiology and chronic health evaluation (APACHE) II score and prognosis of patients with acute cerebral hemorrhage (ACH).
METHODS: A total of 40 ACH patients receiving conservative treatment in our hospital from March 2017 to January 2019 were enrolled as control group, and 40 patients undergoing craniotomy evacuation of hematoma were selected as observation group. All patients enrolled were followed up via outpatient service for 1 year, and the levels of inflammatory factors, CCCK-18, MMP-9 and DD were compared between the two groups at enrollment. The change tendency in the National Institute of Health Stroke Scale (NIHSS) score for neurological function in the two groups was recorded during intervention (at enrollment, at 1 week after enrollment, at discharge and at 1 year of follow-up), and the correlations of APACHE II score with the changes in high-sensitivity C-reactive protein (hs-CRP), CCCK-18, MMP-9 and DD were analyzed. Additionally, relevant factors affecting the neurologic outcomes of ACH patients were subjected to univariate and multivariate analyses.
RESULTS: At enrollment, the levels of inflammatory factors [hs-CRP and interleukin-6 (IL-6)], CCCK-18, MMP-9, and DD were significantly higher in observation grou than those in control group (P<0.05). The NIHSS score was overtly higher in observation group than that in control group at 1 week after enrollment, at discharge, and at 1 year of follow-up (P<0.05), and it was positively correlated with changes in hs-CRP, CCCK-18, MMP-9, and DD (P<0.05). Univariate analysis at 1 year of follow-up showed that the levels of hs-CRP, CCCK-18, MMP-9 and DD were relevant risk factors affecting the neurologic outcomes of ACH patients. Increased hs-CRP, CCCK-18, MMP-9 and DD levels were independent risk factors for poor neurologic outcomes of ACH patients.
CONCLUSIONS: ACH patients receiving emergency operation have a poorer prognosis and a higher APACHE II score than those undergoing conservative treatment. The APACHE II score has positive associations with the levels of inflammatory factors, CCCK-18, MMP-9 and DD. In addition, raised levels of hs-CRP, CCCK-18, MMP-9 and DD are considered as independent risk factors for poor neurologic outcomes of ACH patients.


KEY WORDS: Acute cerebral hemorrhage; Inflammatory factors; CCCK-18, MMP-9, D-Dimer; APACHE II score

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