Bishwas Chamling1, Stefan Gross1, Birgit Stoffel-Wagner2, Gerrit A Schubert3, Hans Clusmann3, Mark Coburn4, Anke Höllig5. 1. Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany and DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Greifswald, Germany. 2. Department of Clinical Chemistry and Clinical Pharmacology, University Hospital of Bonn, Bonn, Germany. 3. Department of Neurosurgery, RWTH Aachen University, Aachen, Germany. 4. Department of Anesthesiology, RWTH Aachen University, Aachen, Germany. 5. Department of Neurosurgery, RWTH Aachen University, Aachen, Germany. Electronic address: ahoellig@ukaachen.de.
Abstract
BACKGROUND: Delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) is one of the main causes of neurologic deterioration. However, it frequently evades timely detection. Early identification and effective reversal may improve the clinical outcome. In this prospective study, we evaluate several serum inflammatory markers after aneurysmal SAH with regard to the occurrence of DCI. METHODS: On days 1, 4, 7, 10, and 14 after SAH, leucocyte count, C-reactive protein, interleukin 6, E-selectin, matrix metallopeptidase 9, intercellular adhesion molecule 1, and leukemia inhibitory factor were assessed in patients' serum samples. Using a Cox regression model (SPSS 21.0), associations of baseline parameters, maximum and delta (maximum minus baseline) values with occurrence of DCI were evaluated. RESULTS: Considering the assessed parameters, leucocyte count (high baseline and delta values) matches most closely with occurrence of DCI. Although baseline levels of C-reactive protein are also associated with occurrence of DCI, neither maximum (only on a borderline level) nor delta levels do so. CONCLUSIONS: Our data analysis identified leucocyte count as the parameter most likely associated with occurrence of DCI. However, because of its lack of specificity leucocyte count, it cannot be used as a biomarker. As hypothesized earlier, the results indicate a possible involvement of the inflammatory reaction after aneurysmal SAH in the pathomechanism of DCI.
BACKGROUND:Delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) is one of the main causes of neurologic deterioration. However, it frequently evades timely detection. Early identification and effective reversal may improve the clinical outcome. In this prospective study, we evaluate several serum inflammatory markers after aneurysmalSAH with regard to the occurrence of DCI. METHODS: On days 1, 4, 7, 10, and 14 after SAH, leucocyte count, C-reactive protein, interleukin 6, E-selectin, matrix metallopeptidase 9, intercellular adhesion molecule 1, and leukemia inhibitory factor were assessed in patients' serum samples. Using a Cox regression model (SPSS 21.0), associations of baseline parameters, maximum and delta (maximum minus baseline) values with occurrence of DCI were evaluated. RESULTS: Considering the assessed parameters, leucocyte count (high baseline and delta values) matches most closely with occurrence of DCI. Although baseline levels of C-reactive protein are also associated with occurrence of DCI, neither maximum (only on a borderline level) nor delta levels do so. CONCLUSIONS: Our data analysis identified leucocyte count as the parameter most likely associated with occurrence of DCI. However, because of its lack of specificity leucocyte count, it cannot be used as a biomarker. As hypothesized earlier, the results indicate a possible involvement of the inflammatory reaction after aneurysmalSAH in the pathomechanism of DCI.
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