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68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Serum markers in aneurysmal and non-aneurysmal subarachnoid hemorrhage – A prospective comparative study

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  • Walid Albanna - Universitätsklinikum der RWTH Aachen, Neurochirurgische Klinik, Aachen, Deutschland
  • Catharina Conzen - RWTH Aachen University, Department of Neurosurgery, Aachen, Deutschland
  • Miriam Weiss - RWTH Aachen University, Department of Neurosurgery, Aachen, Deutschland
  • Hans Clusmann - RWTH Aachen University, Department of Neurosurgery, Aachen, Deutschland
  • Gerrit Schubert - RWTH Aachen University, Department of Neurosurgery, Aachen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMi.11.09

doi: 10.3205/17dgnc436, urn:nbn:de:0183-17dgnc4364

Published: June 9, 2017

© 2017 Albanna et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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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.