Iron Overload is Associated with Perihematoma Edema Growth Following Intracerebral Hemorrhage that may Contribute to In-hospital Mortality and Long-term Functional Outcome
Babak Bakhshayesh, Mozaffar Hosseininezhad, Seyedeh Nazanin Seyed Saadat, Malek Moien Ansar, Hamed Ramezani and Seyed Mohammad Seyed Saadat
Affiliation: Department of Neurology, Guilan University of Medical Sciences, Poursina Hospital, Rasht, Iran, Postal Code: 41686-48676.
Keywords: Edema, ferritin, growth, hematoma, intracerebral hemorrhage, mortality, outcome.
Iron overload may contribute to brain damage that involves delayed brain atrophy, edema, and neuronal cell
death as well as unfavorable outcome following ischemic stroke and intracerebral hemorrhage (ICH). This prospective
study was performed to determine the association of serum ferritin level, an iron storage protein, with perihematoma
edema (PHE) growth as well as in-hospital mortality and long-term clinical outcome of patients with ICH. Data was
collected from patients with ICH from February 2011 to April 2012. Demographic and clinical data were recorded and
serum ferritin was measured on admission. Brain CT scan was performed on admission and 72 hours later. Volume of
hematoma and PHE was calculated using ABC/2 formula. Functional outcome was assessed using modified Rankin Scale.
A total of 63 patients were included in this study, of those 11 (17.5%) patients died during the first 72 hours of admission.
There was a significant correlation between PHE growth during first 72 hours of hospitalization and serum ferritin
(P<0.001) as well as history of diabetes mellitus (P<0.001). PHE growth during the first 72-hours of hospitalization and
baseline hematoma volume were both predictors of in-hospital mortality and poor outcome (P=0.026 and P=0.035,
respectively). These results indicate the role of iron overload in the development of PHE following ICH. However, it
seems that serum ferritin level is not directly associated with in-hospital mortality and long-term functional outcome.
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