Elevated Inflammatory Biomarkers and Poor Outcomes in Intracerebral Hemorrhage

Edward R. Bader* (Corresponding Author), Tiberiu Pana, Raphae Barlas, Anthony K Metcalf, John F Potter, Phyo Kyaw Myint

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)


Accumulating evidence suggests that spontaneous intracerebral haemorrhage (ICH) is associated with a reactive neuroinflammatory response. However, it remains unclear if circulating inflammatory biomarkers are associated with adverse outcomes in ICH. To address this knowledge gap, we conducted a cohort study using a prospectively maintained stroke register in the United Kingdom to assess the prognostic value of admission inflammatory biomarkers in ICH.
The Norfolk and Norwich Stroke and TIA Register recorded consecutive ICH cases. The primary exposures of interest were elevation of white cell count (WCC; >10x109 43 /L), elevation of c-reactive protein (CRP; >10mg/L), and co-elevation of both biomarkers, at the time of admission. Modified Poisson and Cox regressions were conducted to investigate the relationship between co-elevation of WCC and CRP at admission and outcomes following ICH. Functional outcome, multiple mortality timepoints, and length of stay were assessed.
In total, 1714 ICH cases were identified from the register. After adjusting for covariates, including stroke-associated pneumonia, co-elevation of WCC and CRP at admission was independently associated with significantly increased risk of poor functional outcome (RR 1.08 [95% CI 1.01-1.15]) and inpatient mortality (RR 1.21 [95% CI 1.06-1.39]); and increased 90-day (HR 1.22 [95% CI 1.03-1.45]), and 1-year mortality (HR 1.20 [95% CI1.02-1.41]). Individual elevation of WCC or CRP were also associated with poor outcomes.
Elevated inflammatory biomarkers were associated with poor outcomes in ICH. This study indicates that these readily available biomarkers may be valuable for prognostication and underscore the importance of inflammation in ICH.
Original languageEnglish
Pages (from-to)6330–6341
Number of pages12
JournalJournal of Neurology
Early online date22 Jul 2022
Publication statusPublished - 1 Dec 2022

Bibliographical note

The authors gratefully acknowledge the Stroke Data Team at the Norfolk and Norwich University Hospital for data collection and maintenance of the NNUH database.


  • intracerebral haemorrhage
  • stroke
  • outcomes
  • inflammation
  • biomarkers


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