Artikel
Early diagnosis of DCI: Is there relevance for inflammatory biomarkers in routine clinical practice?
Suche in Medline nach
Autoren
-
Bishwas Chamling
- Medizinische Klinik I, Klinikum Vest, Knappschaftskrankenhaus Recklinghausen, Germany
-
Birgit Stoffel-Wagner
- Institut für Klinische Chemie und Klinische Pharmakologie, Universität Bonn, Germany
-
Gerrit A. Schubert
- Klinik für Neurochirurgie, RWTH Aachen, Germany
-
Hans Clusmann
- Klinik für Neurochirurgie, RWTH Aachen, Germany
-
Mark Coburn
- Klinik für Anesthesie, RWTH Aachen, Germany
-
Anke Höllig
- Klinik für Neurochirurgie, RWTH Aachen, Germany
| Veröffentlicht: | 8. Juni 2016 |
|---|
Gliederung
Text
Objective: By clinical as well experimental studies multiple biomarkers have been proposed to predict delayed cerebral ischemia (DCI) after aneurysmal SAH at an early stage. So far, none of these biomarkers are used in everyday practice. Here, we review a panel of biomarkers for their value predicting DCI in routine clinical setting.
Method: Within a 21-months-period 89 patients with aneurysmal SAH were prospectively included. Occurrence of DCI was defined either as secondary neurological worsening (increase on modified NIHSS ≥ 2 points and exclusion of other causes) with improvement after induced hypertension or occurrence of new cerebral ischemia or perfusion deficit. Serum (CRP, leucocyte count, IL-6, E-selectin, ICAM, MMP-9, LIF) and cerebral spinal fluid parameters (IL-6, E-selectin, ICAM, MMP-9, LIF) were assessed at days 1, 4, 7, 10 and 14 after SAH. CSF only was examined in patients with clinical necessity for external ventricular drainage (n=46). Serum and CSF parameters were related to occurrence of DCI using SPSS 21.0 and Graphpad Prism 6.04.
Results: In 24 patients (27%) DCI was detected. Comparing the patients with and without DCI there was no difference in gender ratio (p=.237, Chi square test), age (p=.108, independent t-test) and aneurysm treatment (p=.342, Chi square test) but occurrence of DCI correlated significantly with severity of SAH (WFNS 4-5 upon admission; p=.030, Chi square test) with lower grading in the DCI group. None of the serum or the CSF parameters proved significant difference in the repeated measures model (ANOVA) with DCI as the between-subjects effect. If related to initiation of DCI no clear peak of any biomarker was observed.
Conclusions: Due to the wide range of individual values the proposed biomarkers do not seem to be feasible in routine clinical practice. Unspecific systemic inflammation reaction and frequent occurrence of concomitant infections may account for this large variance.
