Inflammation as a predictor for delayed cerebral ischemia after aneurysmal subarachnoid haemorrhage

Autor: Andrew T. King, Debi Smith, Simon M. Clark, Catherine McMahon, Stephen J. Hopkins, Pippa J. Tyrrell, Andy Vail, Karen J. Illingworth, Nancy J. Rothwell
Rok vydání: 2012
Předmět:
Male
Leukocytosis
Gastroenterology
Brain Ischemia
Brain ischemia
Cohort Studies
Leukocyte Count
Medicine
Prospective Studies
Prospective cohort study
medicine.diagnostic_test
biology
General Medicine
Middle Aged
Prognosis
C-Reactive Protein
Anesthesia
Predictive value of tests
Erythrocyte sedimentation rate
Data Interpretation
Statistical
Female
medicine.symptom
Inflammation Mediators
Adult
medicine.medical_specialty
Subarachnoid hemorrhage
Ischemia
Hemorrhage
Blood Sedimentation
Young Adult
Predictive Value of Tests
Internal medicine
Inflammatory Response
Humans
Aged
Ischemic Stroke
Inflammation
Subarachnoid
business.industry
Interleukin-6
Patient Selection
C-reactive protein
Subarachnoid Hemorrhage
medicine.disease
Aneurysm
Cerebral Angiography
Interleukin 1 Receptor Antagonist Protein
Case-Control Studies
biology.protein
Surgery
Neurology (clinical)
business
Zdroj: Journal of Neurointerventional Surgery
ISSN: 1759-8486
Popis: Background The mechanism of development of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (SAH) is poorly understood. Inflammatory processes are implicated in the development of ischemic stroke and may also predispose to the development of DCI following SAH. The objective of this study was to test whether concentrations of circulating inflammatory markers (C-reactive protein (CRP), interleukin-6 (IL-6) and interleukin 1 receptor antagonist (IL-1Ra)) were predictive for DCI following SAH. Secondary analyses considered white cell count (WCC) and erythrocyte sedimentation rate (ESR). Methods This was a single-center case-control study nested within a prospective cohort. Plasma inflammatory markers were measured in patients up to 15 days after SAH (initial, peak, average, final and rate of change to final). Cases were defined as those developing DCI. Inflammatory markers were compared between cases and randomly selected matched controls. Results Among the 179 participants there were 46 cases of DCI (26%). In primary analyses the rate of change of IL-6 was associated with DCI (OR 2.3 (95% CI 1.1 to 5.0); p=0.03). The final value and rate of change of WCC were associated with DCI (OR 1.2 (95% CI 1.0 to 1.3) and OR 1.3 (95% CI 1.0 to 1.6), respectively). High values of ESR were associated with DCI (OR 2.4 (95% CI 1.3 to 4.6) initial; OR 2.3 (95% CI 1.3 to 4.2) average; OR 2.1 (95% CI 1.1 to 3.9) peak; and OR 2.0 (95% CI 1.2 to 3.3) final value). Conclusions Leucocytosis and change in IL-6 prior to DCI reflect impending cerebral ischemia. The time-independent association of ESR with DCI after SAH may identify this as a risk factor. These data suggest that systemic inflammatory mechanisms may increase the susceptibility to the development of DCI after SAH.
Databáze: OpenAIRE
Externí odkaz: