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ORIGINAL ARTICLE
Year : 2018  |  Volume : 5  |  Issue : 2  |  Page : 127-133

Inflammatory markers and cerebral vasospasm after aneurysmal subarachnoid hemorrhage


1 Intensive Care Unit Department, Nasser Institute of Research and Treatment, Egypt
2 Critical Care Department, Cairo University, Cairo, Egypt

Correspondence Address:
Mahmoud M Kenawi
47, Zahraa Al-Maadi, Cairo, 11728
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/roaic.roaic_35_17

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Background Aneurysmal subarachnoid hemorrhage (aSAH) is considered a major cause of morbidity and mortality. It accounts for about 85% of spontaneous SAH. Cerebral vasospasm is a devastating complication of aSAH. Aim The aim of this study was to evaluate the probable etiological determinant, the outcome of aSAH, and the role of inflammatory markers in predicting cerebral vasospasm post-SAH. Patients and methods A prospective cohort study was conducted on aSAH patients who attended the Emergency Unit, Outpatient Clinics of Neurosurgery Department, and the ICU in Nasser Institute of Research and Treatment during the period between July 2014 and September 2016. Inflammatory marker samples were collected on days 0, 1, 3, 7, and 9. Patients were divided into two groups: (i) group A, which included patients with cerebral vasospasm (n=35) and (ii) group B, which included patients without cerebral vasospasm (n=25). Results A total of 60 patients were enrolled. The mean age was highly significant between both groups (51.31±10.46 years in group A vs. 43.12±8.77 years in group B, P=0.002). The overall mortality was 18 patients, all of which in group A (P<0.001). The univariate analysis showed that C-reactive protein, total leukocytic count, and interleukin-6 had a significant statistical difference between both groups throughout the follow-up period (P<0.05). The optimal cutoff points as cerebral vasospasm indicator in days 0, 1, 3, 7, 9 were (i) 2.7, 4.6, 6.35, 7.45, and 3.8 mg/l for C-reactive protein; (ii) 9.79×109/l, 13.45×109/l, 9.75×109/l, 11.09×109/l, and 12.65×109/l for total leukocytic count; and (iii) 3.15, 3.95, 3.75, 5.1, and 5 pg/ml for interleukin-6, respectively. Conclusion A strong correlation exists between inflammation, cerebral vasospasm, and poor survival outcomes among patients presenting with aSAH. Inflammation and inflammatory markers are dependent risk factors for mortality after cerebral vasospasm.


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