Serum substance P levels and early mortality of spontaneous intracerebral haemorrhage patients

J Stroke Cerebrovasc Dis. 2020 Jul;29(7):104893. doi: 10.1016/j.jstrokecerebrovasdis.2020.104893. Epub 2020 May 13.

Abstract

Introduction and goal: Substance P, a neuropeptide of the tachykinin family, is involved in the neuroinflammation of different diseases of the central nervous system. To our knowledge, there is no published data on the level of circulating substance P levels in the prognosis of patients with spontaneous intracerebral hemorrhage (ICH). Therefore, the objectives of this observational and prospective study were to determine whether serum substance P levels in ICH patients were associated with early mortality and whether could be used in the mortality prognostic.

Material and methods: We included patients with severe primary supratentorial ICH (defined as Glasgow Coma Scale < 9) from 6 Intensive Care Units of Spanish hospitals. We determined serum substance P levels at the time of severe ICH diagnosis, at fourth and at eighth day. Thirty-day mortality was considered the end-point study.

Findings: Non-surviving (n=53) compared to surviving ICH patients (n=64) showed higher serum substance P levels at day 1 (p<0.001), day 4 (p<0.001) and day 8 (p<0.001). The area under the curve for 30-day mortality prediction by serum substance P levels was of 79% (95% CI = 70-86%; p<0.001). Kaplan-Meier analysis showed a higher 30-day mortality in patients with serum substance P levels>503 pg/mL (Hazard ratio=14.7; 95% CI=6.88-31.55; p<0.001). Multiple logistic regression analysis showed an association between serum substance P levels and 30-day mortality (Odds Ratio=1.006; 95% CI=1.002-1.010; p=0.004) controlling for ICH score, midline shift, glycemia, early evacuation of ICH.

Conclusions: Thus, the novel aspects our study include that serum substance P levels in severe primary ICH patients were higher in non-surviving than in surviving patients, that serum substance P levels were associated with early mortality controlling for other variables, and that serum substance P levels could be used as biomarkers of prognosis.

Keywords: Mortality; Outcome; Spontaneous intracerebral hemorrhage; Substance P.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Aged
  • Biomarkers / blood
  • Cerebral Hemorrhage / blood*
  • Cerebral Hemorrhage / diagnosis
  • Cerebral Hemorrhage / mortality*
  • Female
  • Glasgow Coma Scale
  • Hospital Mortality
  • Humans
  • Intensive Care Units
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • Risk Assessment
  • Risk Factors
  • Spain
  • Substance P / blood*
  • Time Factors
  • Up-Regulation

Substances

  • Biomarkers
  • Substance P