Lower serum NfL and GFAP levels correlate with favorable outcomes after intracerebral hemorrhage evacuation

Spontaneous supratentorial intracerebral haemorrhage (SSICH) is a devastating condition, and the benefit of surgical haematoma evacuation in reducing brain damage remains unclear. Current methods struggle to quantify the efficacy of surgical interventions or accurately prognosticate clinical outcomes. Blood biomarkers reflecting brain damage and inflammation, such as neurofilament light chain (NfL) and glial fibrillar acidic protein (GFAP), offer a promising avenue to address this gap by providing objective measures of neuronal and astrocytic injury, respectively, which could guide treatment decisions and assess intervention success.

Researchers collected longitudinal blood samples from 10 patients with SSICH participating in the phase II EMINENT-ICH pilot study (NCT04805177). Samples were taken at baseline, 24 hours, 3 days, 1 week, 1 month, and 6 months after surgical haematoma evacuation. They quantified serum levels of NfL, GFAP, S100B, and inflammatory markers including interferon-gamma, IL-1β, IL-2, IL-6, IL-8, IL-10, and tumour necrosis factor alpha using unspecified immunoassay methods. The study assessed the perioperative and long-term course of these concentrations and their association with clinical outcomes, defined as a modified ranking scale (mRS) of ≤3 for a favourable outcome.

A favourable clinical outcome (mRS ≤3) was observed in 60% (6/10) of patients at 6 months. The preset goal of a postsurgery haematoma volume below 15 mL was achieved in 70% (7/10) of patients. Patients with unfavourable outcomes at 6 months exhibited significantly higher biomarker concentrations: on average, twofold higher NfL (p=0.127) and sixfold higher GFAP (p=0.017) compared to those with favourable outcomes. Notably, biomarker levels were also elevated in cases of unsatisfactory haematoma evacuation. > Concentrations of NfL were 3.7-fold higher (p=0.0072) and GFAP concentrations were 12.4-fold higher (p=0.0122) in patients where the target haematoma volume was not met. Concentrations of other inflammatory markers, particularly interleukins, did not show a clear association with functional outcomes in this cohort.