1Neurological Surgery Service at ValleSalud Clinical Network, Cali, Colombia; 2MEDITECH Foundation, Bogota, Colombia; 3Division of Neurosurgery and LIM 62, University of Sao Paulo Medical School, Sao Paulo, Brazil
Correspondence: Wellingson Silva Paiva, Division of Neurosurgery, University of Sao Paulo, Eneas Aguiar Ave 255, Sao Paulo, 05403000, Brazil, Email [email protected]
Dear editor
The insightful study conducted by Ji et al1 offers an innovative approach through the integration of diverse clinical, inflammatory, and radiological parameters, significantly enhancing the ability to predict hematoma expansion. This critical phenomenon is closely linked to poor functional outcomes and increased mortality rates, making effective prediction crucial. Notably, the study incorporates vital inflammatory indices, including the neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) levels, which highlight the systemic inflammatory status as a pivotal predictor of intracerebral bleeding progression.3,4 The exploration of these biomarkers, together with advanced radiological indicators like the “black hole sign” and the “spot sign” observed on CT angiography (CTA), significantly fortifies the predictive model’s capacity for anticipating hematoma expansion. This development allows for timely therapeutic interventions.5 Furthermore, the introduction of the BAT score serves as a pragmatic tool for swift risk assessment in acute clinical scenarios, promoting better patient management.1,2 The validation of predictive frameworks like the one proposed by Ji et al1 is consistent with recent studies that underline the significance of biomarkers not just for outcome prediction but also for directing clinical interventions, especially in settings with limited resources.2 This multidimensional approach marks a considerable advancement in the realm of evidence-based medicine, providing a valuable resource for clinical decision-making in high-stakes scenarios.
However, the study is not without its methodological limitations that warrant consideration for future research endeavors. The retrospective and single-center design inherently restricts the generalizability of the findings, highlighting the necessity for multicenter validations involving more diverse populations to confirm the model’s practical utility. The research’s reliance on Computed Tomography Angiography (CTA) may also limit its application in resource-constrained environments. This underlines the pressing need to devise alternative models that can rely solely on non-contrast computed tomography (NCCT).1,2 An in-depth exploration of how modulation of inflammatory biomarkers, such as CRP, may impact long-term clinical outcomes would be beneficial. Additionally, investigating whether early intervention strategies based on these biomarkers could potentially alter the disease trajectory is essential. The variability in the interpretation of radiological signs indicates a pressing need to standardize imaging protocols. This would significantly reduce interobserver discrepancies and boost the reproducibility of results across various medical centers.1,2 Lastly, integrating novel biomarkers, such as secretoneurin, into future studies could substantially enhance the precision of predictive models and ultimately improve patient outcomes.
Disclosure
The authors report no conflicts of interest in this communication.
References
1. Zeqiang J, Wanxing Y, Wen X, Zhao X, Li N. Predicting intracerebral hemorrhage expansion with inflammation indices. non-contrast computed tomography signs and computed tomography angiography spot sign. Neuropsychiatr Dis Treat. 2024;20:1879–1887. doi:10.2147/NDT.S475550
2. Xin-Ni L, Qiao Li Z, Li Q. Blood- based biomarkers in intracerebral hemorrhage. J Clin Med. 2023;12(20):562. doi:10.3390/jcm12020562
3. Di Napoli M, Parry-Jones AR, Smith CJ, et al. C-reactive protein predicts hematoma growth in intracerebral hemorrhage. Stroke. 2013;45(1):204–209.
4. Boulis G, Morotti A, Brouwers HB, et al. Association between hypodensities detected by computed tomography and hematoma expansion in patients with intracerebral hemorrhage. JAMA Neurol. 2016;73(8):961–968. doi:10.1001/jamaneurol.2016.1218
5. Wada R, Aviv RI, Fox AJ, et al. CT angiography “spot sign” predicts hematoma expansion in acute intracerebral hemorrhage. Stroke. 2007;38(4):1257–1262. doi:10.1161/01.STR.0000259633.59404.f3
