Tigecycline reduced tumor necrosis factor alpha level and inhospital mortality in spontaneous supratentorial intracerebral hemorrhage

Medical Journal of Indonesia
Vol. 25 No. 2 (2016): June

Background: 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: Pasien dengan PISS yang akan dilakukan evakuasi hematoma, dirandomisasi untuk jenis antibiotik profilaksis tigesiklin (n=35) atau fosfomisin (n=37). Pada semua subjek diukur kadar TNF-α sebelum pembedahan serta hari ke-1 dan ke-7 pascabedah. Pada hari ke-7 dilakukan pemeriksaan CT Scan ulang. Skor Glasgow outcome scale (GOS) dan lama rawat dicatat pada saat keluar rumah sakit. Data dianalisis dengan uji Mann-Whitney atau uji kai kuadrat. Efektivitas klinis relatif dinilai dengan menghitung number needed to treat (NNT). Results: Didapatkan perbedaan bermakna pada proporsi subjek yang mengalami penurunan kadar TNF-α pada kelompok tigesiklin dibanding fosfomisin pada hari ke-7 pascabedah (62% vs 29%, p=0,022). Pengurangan edema pacsa operasi berbeda tidak bermakna pada kedua kelompok (86% vs 80%, p=0,580). Tigesiklin menunjukkan efektivitas klinis mengurangi luaran buruk (GOS ≤ 2 (20% vs 38% ; p=0,096; OR=0,41; NNT=6) dan inhospital mortality (17% vs 35%; p=0,083; OR=0,49; NNT=5). 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.