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J Neurol Surg A Cent Eur Neurosurg 2019; 80(05): 371-380
DOI: 10.1055/s-0039-1677827
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Spontaneous Aneurysmal Subarachnoid Hemorrhage and Related Cortisol and Immunologic Alterations: Impact on Patients' Health-related Quality of Life

Sami Ridwan
1   Department of Neurosurgery, Universitatsklinikum Bonn, Bonn, Nordrhein-Westfalen, Germany
3   Department of Neurosurgery, Evangelisches Klinikum Bethel, Bielefeld, Germany
,
Susanne Greschus
2   Department of Radiology, Universitatsklinikum Bonn, Bonn, Nordrhein-Westfalen, Germany
,
Jan Boström
1   Department of Neurosurgery, Universitatsklinikum Bonn, Bonn, Nordrhein-Westfalen, Germany
,
Julio Barrera
1   Department of Neurosurgery, Universitatsklinikum Bonn, Bonn, Nordrhein-Westfalen, Germany
,
Jonas Esche
4   Department of Nutrition and Food Science, Universität Bonn, Bonn, Germany
,
Bernd Zur
5   Department of Clinical Chemistry and Pharmacology, Universitatsklinikum Bonn, Bonn, Nordrhein-Westfalen, Germany
,
Dietrich Klingmüller
6   Division of Endocrinology and Diabetes, Department of Medicine I, Universitatsklinikum Bonn, Bonn, Nordrhein-Westfalen, Germany
,
Azize Boström
1   Department of Neurosurgery, Universitatsklinikum Bonn, Bonn, Nordrhein-Westfalen, Germany
› Author Affiliations
Further Information

Publication History

29 July 2018

19 November 2018

Publication Date:
04 July 2019 (online)

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Abstract

Objective To highlight the impact of aneurysmal subarachnoid hemorrhage (SAH) on surviving patients' health-related quality of life (HRQoL) with respect to cortisol and interleukin (IL)-6 alterations and also to identify possible clinical predictors for a better HRQoL.

Methods Fifty surviving patients treated in our hospital for aneurysmal SAH in a 2-year period with sufficient HRQoL data were enrolled. A good clinical outcome was represented by the modified Rankin Scale (mRS) 0 to 2. The patient's HRQoL was assessed using the Short Form health survey questionnaire, the Beck Depression Inventory, and the Daily Fatigue Impact Scale at 6 and 12 months. The results were analyzed regarding possible correlation to 24-hour urinary free cortisol, serum, and cerebrospinal fluid IL-6 levels.

Results A reduction of HRQoL in up to 35% of survivors was observed at 6 months and in a high proportion of patients (47.2%) with an assumable good outcome (mRS 0–2). Reduced HRQoL in survivors was found in terms of SF-36 (34.9%), depression (26.8%), and fatigue (14%) at 6 months and 18.4%, 39.4%, and 18.9% at 12 months, respectively. Improvement was recorded at 12 months, mainly in SF-36. Early elevated 24-hour urinary free cortisol and IL-6 levels showed a significant positive impact on HRQoL.

Conclusions Early cortisol and IL-6 levels may predict patients' HRQoL after SAH. Twelve months after SAH, a considerable percentage of patients with a presumably good outcome (mRS 0–2) had a lower HRQoL compared with the general population. Implementing corresponding tests at discharge and 12-month follow-up is recommended.

Keywords

health-related quality of life - subarachnoid hemorrhage - neurosurgery - vascular
 

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