Tigecycline reduced tumor necrosis factor alpha level and inhospital mortality in spontaneous supratentorial intracerebral hemorrhage
Abstract: The outcome of
patients with spontaneous supratentorial intracerebral hemorrhage (SSICH) is
unsatisfactory. Inflammatory response secondary to brain injury as well as
those resulted from surgical procedure were considered responsible of this
outcome. This study was intended to elucidate the anti-inflammatory activity of
tigecycline by measuring TNF-α level and its neuroprotective effect as
represented by inhospital mortality rate.
Methods: Patients with SSICH who were prepared for hematoma evacuation
were randomized to receive either tigecycline (n=35) or fosfomycine (n=37) as
prophylactic antibiotic. TNF-α level was measured in all subjects before
surgery and postoperatively on day-1 and day-7. A repeated brain CT Scan was
performed on postoperative day-7. The Glasgow outcome scale (GOS) and length of
stay (LOS) were recorded at the time of hospital discharge. Data were analyzed
using Mann-Whitney and Chi square test. Relative clinical effectiveness was
measured by calculating the number needed to treat (NNT).
Results: There was a significant difference regarding the proportion of
subject who had reduced TNF-α level on
postoperative day-7 between the groups receiving tigecycline and fosfomycine
(62% vs 29%, p=0.022). Decrease brain edema on CT control (86% vs 80%,
p=0.580). Tigecycline administration showed a tendency of better clinical
effectiveness in lowering inhospital mortality (17% vs 35%; p=0.083; OR=0.49;
NNT=5) and worse clinical outcome / GOS ≤ 2 (20% vs 38% ; p=0.096; OR=0.41;
NNT=6). LOS ≥ 15 hari ( 40% vs 27%; p=0.243; OR=1.81; NNT=8).
Conclusion: Tigecycline showed anti-inflammatory and neuroprotective
activities. These activities were associated with improved clinical outcome in
patients with SSICH after hematoma evacuation.
Author: Mohamad Saekhu, Hilman
Mahyuddin, Tegus A.S. Ronokusumo, Sudigdo Sastroasmoro
Journal Code: jpkedokterangg160148
