Artikel
Prognostic potential of early inflammatory parameters after subarachnoid hemorrhage
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Autoren
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Anke Höllig
- UniversityKlinik für Neurochirurgie, Universität, Universität RWTH Aachen, Aachen, Deutschland; Klinik für Anästhesiologie, Universität RWTH Aachen, Aachen, Deutschland
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Daniel Remmel
- Neurochirurgische Klinik der Heinrich-Heine-Universität, Düsseldorf, Deutschland
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Birgit Stoffel-Wagner
- Institut für Pharmakoloige, Universität Bonn, Bonn, Deutschland
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Mark Coburn
- Klinik für Anästhesiologie, Universität RWTH Aachen, Aachen, Deutschland
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Hans Clusmann
- UniversityKlinik für Neurochirurgie, Universität, Universität RWTH Aachen, Aachen, Deutschland
| Veröffentlicht: | 2. Juni 2015 |
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Gliederung
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Objective: Neuroimmune response is involved in early brain injury after aneurysmal subarachnoid hemorrhage (aSAH). Nevertheless, its relevance for functional outcome and its role as outcome predictor remains uncertain. Here, we evaluate various early inflammatory parameters regarding functional outcome according to modified Rankin Scale score (mRS) at discharge (primary objective) and six months after aSAH to clarify their prognostic value.
Method: At admission clinical data, various inflammatory parameters in serum and – wherever applicable – cerebrospinal fluid (CSF) of patients after aSAH were assessed. Outcome was evaluated according to dichotomized mRS at discharge and six months after aSAH (unfavorable outcome: mRS 3-6). Univariate and thereafter multivariate logistic regression was performed using SAS 9.2.
Results: Of 109 patients who were assessed for eligibility, 81 patients (63% females) with a mean age of 53.8 ± 13.2 yrs were included. Applying a univariate model, elevated levels of interleukin 6 (IL-6) and leukemia inhibitory factor (LIF) in serum and CSF were related to unfavorable outcome at discharge (p<0.05). When using a multivariate model and including the relevant baseline characteristics the only remaining parameter with relevance for outcome was serum IL-6. We could not identify any correlation after six months, most likely due to the high drop-out rate (27%). A pronounced rise of LIF serum and CSF levels after aSAH was observed for the first time.
Conclusions: Higher early IL-6 serum levels after aSAH have proven its prognostic value for poor outcome at discharge. Additionally, involvement of LIF in the early inflammatory reaction after aSAH has been demonstrated.
