Baseline IL-6 Levels Are Associated with Midline Shift and Functional Outcome in Spontaneous Intracerebral Hemorrhage: An Exploratoryanalysis of the Fast Trial
Leasure A, Kuohn L, King Z, Bevers M, Kimberly WT, Shi FD, Mayer S, Steiner T, Sansing L, Falcone G, and Sheth K. Baseline IL-6 Levels Are Associated with Midline Shift and Functional Outcome in Spontaneous Intracerebral Hemorrhage: An Exploratoryanalysis of the Fast Trial. Eur Stroke J 2019; 4:129.
Eur Stroke J
Background and Aims: Interleukin-6 (IL-6), a proinflammatory cytokine, is an established biomarker in acute brain injury, but the clinical significance of IL-6 in spontaneous intracerebral hemorrhage (ICH) has not been well studied. We aim to determine whether IL-6 levels are associated with secondary injury and functional outcome after ICH in a clinical trial cohort. Methods: We performed an exploratory analysis of the recombinant activated factor VII for acute ICH (FAST) trial. Patients with baseline serum IL-6 levels were included. Regression analyses were used to assess the associations between IL-6, 24-hour midline shift, and 90-day modified Rankin scale (mRS). Results: Of 841 enrolled patients, 557 (66%) had baseline IL-6 levels (mean age 64 [SD 13], female sex 203 [37%) and were included. ICH location was deep in 437 (78%) patients and lobar in 78 (22%). IL-6 levels were associated with ICH volume (b 0.26; 95% CI 0.17- 0.35; p<0.001) and were higher in patients with lobar versus deep ICH (7.4 ng/L [IQR 10.1] vs 4.0 ng/L [IQR 5.1]; p=0.004). IL-6 was associated with midline shift (b 0.40; 95%CI 0.10-0.69; p=0.009) after adjustment for ICH volume. IL-6 was associated with worse mRS (OR 1.43; 95% CI 1.22- 1.69; p=0.001) after adjustment for age, sex, ICH volume, GCS, intraventricular hemorrhage, hematoma expansion, location, and treatment. Treatment was not associated with IL-6 or outcome. Conclusions: In the FAST trial population, baseline IL-6 levels were associated with 24-hour midline shift and functional outcome. These results warrant further investigation of IL-6 as a biomarker for secondary injury and outcome after ICH.