Artikel
Serum markers in aneurysmal and non-aneurysmal subarachnoid hemorrhage – A prospective comparative study
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Autoren
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Walid Albanna
- Universitätsklinikum der RWTH Aachen, Neurochirurgische Klinik, Aachen, Deutschland
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Catharina Conzen
- RWTH Aachen University, Department of Neurosurgery, Aachen, Deutschland
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Miriam Weiss
- RWTH Aachen University, Department of Neurosurgery, Aachen, Deutschland
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Hans Clusmann
- RWTH Aachen University, Department of Neurosurgery, Aachen, Deutschland
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Gerrit Schubert
- RWTH Aachen University, Department of Neurosurgery, Aachen, Deutschland
| Veröffentlicht: | 9. Juni 2017 |
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Gliederung
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Objective: Non-aneurysmal subarachnoid hemorrhage (naSAH) is characterised by milder clinical presentation and course compared to aneurysmal subarachnoid hemorrhage (aSAH), despite comparable blood distribution on admission CT scanning. A fundamental difference in the underlying etiology (venous tearing vs. aneurysmal rupture) is generally assumed, implying also that a different pathophysiological cascade is triggered in the very acute phase; this assumption, however, lacks further characterisation. The objective of this study was to evaluate selected, systemic biomarkers in the acute phase of aneurysmal and non-aneurysmal SAH in order to further clarify pathophysiological discrepancies.
Methods: A total of 41 patients with verified aSAH (mean age 56.1±12.3 years; aSAHHH°1-3, n=21; aSAHHH°4-5, n=20) and 14 patients with naSAH (mean age 55.3±12.8 years; all HH°1-3) were prospectively recruited for this study. Blood samples were obtained within the first 48hrs after hemorrhage and analyzed for the following parameters: glucose, lactate, bilirubin, urea, CRP, procalcitonin, leukocyte count, S100, TNF-alpha, IL-6.
Results: Serum markers were comparable without statistically significant difference for naSAH patients and patients of lower HH-grade (aSAHHH°1-3). Glucose level, leukocyte count and S100 were significantly higher in patients with higher HH-grade (aSAHHH°4-5) when compared to patients with naSAH (p<0.01, p<0.01, p<0.001) and aSAHHH°1-3 (p<0.01, p<0.05, p<0.01). IL-6 was significantly lower in patients with naSAH compared to aSAHHH°4-5 patients (p<0.01), while comparison with aSAHHH°1-3 patients failed to reach statistical significance for both naSAH and aSAHHH°4-5 patients (p<0.1). Lactate, bilirubin, urea, CRP, TNF-alpha and broader inflammatory markers (CRP, procalcitonin) were comparable in all groups.
Conclusion: In low-grade aSAH patients (aSAHHH°1-3), systemic parameters are comparable to those in non-aneurysmal SAH patients, implying a comparable severity of the initial insult despite an assumed difference in underlying etiology. Severely affected patients (aSAHHH°4-5) feature pronounced hyperglycemia, leukocytosis and elevation of S100 and IL-6 in the very acute phase after hemorrhage, attributable to the severity of the initial insult.
