Abstract
Background Subarachnoid hemorrhage (SAH) is a severe condition associated with high mortality.
Early brain injury (EBI) plays an important role in the pathophysiology of SAH, and
inflammation is a major contributor to EBI. Inflammation is a widely studied topic
in both experimental and clinical conditions; however, just a few clinical studies
have focused primarily on the early inflammatory response after SAH, and detailed
information about the association between the dynamics of early inflammatory response
with main clinical characteristics is lacking. This study analyzes the early dynamics
of inflammatory response after SAH and evaluates the possible associations between
the markers of early inflammatory response and main clinical characteristics.
Patients and Methods A total of 47 patients with a diagnosis of aneurysmal SAH within the last 24 hours
were enrolled in the study. All treatments, including treatment of aneurysm (surgery/coiling)
and implantation of a drainage system (external ventricular drainage/lumbar catheter),
were conducted in the same way as in other patients with this diagnosis. Blood and
cerebrospinal fluid (CSF) samples were collected three times a day for 4 days. The
dynamics of proinflammatory cytokines were assessed, and associations between levels
of the proinflammatory cytokines interleukin (IL)-6, IL-1β, or tumor necrosis factor
(TNF)α and main clinical characteristics were evaluated using linear mixed-effect
models.
Results The CSF levels of IL-6 were massively increased initially after SAH (up to 72 hours)
with an additional increase in later phases (after 72 hours), but there was high variability
in IL-6 levels. A significant association was noted between the Glasgow Outcome Scale
score and both overall levels of IL-6 (p = 0.0095) and their dynamics (p = 0.0208); the effect of the Hunt and Hess scale was borderline (p = 0.0887). No association was found between IL-6 levels and Fisher grade, modality
of treatment (surgery, coiling, no treatment), and later development of cerebral vasospasm.
Plasmatic levels of IL-6 increased slightly, but no significant association was found.
The levels of IL-1β and TNFα were within the physiologic range in both CSF and plasma.
Conclusions Early dynamics of IL-6 in CSF are associated with a patient́s outcome. But it is
difficult to use IL-6 alone for outcome prediction due to its high variability. The
question is whether the dynamics of IL-6 could be used in combination with other early
markers associated with brain injury. More detailed research is required to answer
this question.
Keywords
subarachnoid hemorrhage - early brain injury - inflammation - IL-6
