Artikel
Significant correlation of inflammatory parameters and outcome after aneurysmal subarachnoid hemorrhage
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Autoren
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Anke Hoellig
- Department of Neurosurgery, RWTH Aachen, Germany
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Bishwas Chamling
- University Bonn, Germany
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Birgit Stoffel-Wagner
- Department of Clinical Chemistry and Clinical Pharmacology, University of Bonn, Bonn, Germany
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Hans Clusmann
- Department of Neurosurgery, RWTH Aachen, Germany
| Veröffentlicht: | 21. Mai 2013 |
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Gliederung
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Objective: To evaluate a potential predictive value of inflammatory serum and cerebrospinal fluid (CSF) parameters in patients with aneurysmal subarachnoid hemorrhage (aSAH) at admission and during further course on patient's outcome.
Method: Prospective study including 89 patients (58 female, 31 male) with a mean age of 53.4 (± 12.7) yrs suffering from aSAH. Serum concentrations of C-reactive protein (CRP), Interleukin-6 (IL-6), Matrixmetalloproteinase-9 (MMP-9) and leucocyte count were performed at day 0, 1, 4, 7, 10 and 14 after admission. CSF was analyzed (MMP-9 and IL-6) at day 1, 4, 7, 10 and 14. Infectious complications as well as occurrence of DIND (delayed ischemic neurological deficit) during further course were documented, correlation with clinical status (modified Rankin scale) at discharge was performed (SPSS 20).
Results: Higher leucocyte count at admission correlated with poorer outcome as well as at day 4, 7, 10 and 14 (p<0.05), correlation at day 4 was not significant (p=0.053). Not at admission, but from day 1 elevated serum CRP-levels showed a significant correlation with poorer outcome at discharge (p<0.01). During the early course, IL-6 serum concentration did not correlate with outcome, but showed a significant correlation from day 4 on. CSF levels of IL-6, MMP-9 serum and CSF levels did not correlate with outcome. Common clinical scores of aSAH severity (Hunt and Hess; WFNS, Fisher) were reliable prognostic parameters (p<0.01). Worse outcome was not directly related to the occurrence of DIND. Gender was not correlated with outcome.
Conclusions: Still it is not possible to forecast outcome after aSAH. A recently discussed factor for poor outcome is early brain injury triggering a pathological cascade, even more important than the pure occurrence of DIND. Our results could support this hypothesis. Relatively unspecific inflammatory parameters show a good correlation with outcome. This may reflect a first unspecific step of an inflammatory cascade triggered by aSAH.
