gms | German Medical Science

Objective: Aneurysmal subarachnoid hemorrhage (SAH) has been reported to induce an intrathecal inflammatory reaction reflected by cytokine release, particularly by interleukin-6 (IL-6), which correlates with early brain damage and poor clinical outcome. The present study examines the correlation of intrathecal IL-6 with clinical parameters as a possible predictor for posthemorrhagic shunt dependency.

Method: Among 186 SAH patients admitted between 07/2010 and 12/2012, 82 received an external ventricular drainage for acute hydrocephalus. In these patients, cerebrospinal fluid (CSF) concentrations of IL-6 were measured every two days within the first 14 days after SAH. Patients in whom IL-6 values were not determined regularly and those who did not survive until discharge were excluded. The peak values of IL-6, microbial CSF culture, patient’s age and sex, Hunt & Hess grade, aneurysm location, and the outcome at discharge were assessed as potential predictors for shunt dependency.

Results: Sixty-nine patients were included, 24 of whom underwent shunt surgery. Peak IL-6 values of >10 000 pg/ml were significantly associated with a higher incidence of posthemorrhagic shunt-dependent hydrocephalus (p=0.009, RR=4.136). Additional risk factors were anterior and posterior aneurysm location (p=0.025, RR=3.611), and age ≥60 years (p=0.014, RR=3.690). Positive CSF cultures narrowly failed in predicting shunt dependency.

Conclusions: The development of shunt-dependent posthemorrhagic hydrocephalus is a multifactorial process, in which neuroinflammation seems to play a key role. CSF IL-6 values of >10000 pg/ml in the early post-SAH period may provide a useful diagnostic tool for the prediction of shunt dependency in patients with acute posthemorrhagic hydrocephalus.