Inflammation in delayed ischemia and functional outcomes after subarachnoid hemorrhage

BackgroundInflammatory mechanism has been implicated in delayed cerebral ischemia (DCI) and poor functional outcomes after subarachnoid hemorrhage (SAH). Identification of cytokine patterns associated with inflammation in acute SAH will provide insights into underlying biological processes of DCI and poor outcomes that may be amenable to interventions.MethodsSerum samples were collected from a prospective cohort of 60 patients with acute non-traumatic SAH at four time periods (<24h, 24-48h, 3-5days, and 6-8days after SAH) and concentration levels of 41 cytokines were measured by multiplex immunoassay. Logistic regression analysis was used to identify cytokines associated with DCI and poor functional outcomes. Correlation networks were constructed to identify cytokine clusters.ResultsOf the 60 patients enrolled in the study, 14 (23.3%) developed DCI and 16 (26.7%) had poor functional outcomes at 3months. DCI was associated with increased levels of PDGF-ABBB and CCL5 and decreased levels of IP-10 and MIP-1 alpha. Poor functional outcome was associated with increased levels of IL-6 and MCP-1 alpha. Network analysis identified distinct cytokine clusters associated with DCI and functional outcomes.ConclusionsSerum cytokine patterns in early SAH are associated with poor functional outcomes and DCI. The significant cytokines primarily modulate the inflammatory response. This supports earlier SAH studies linking inflammation and poor outcomes. In particular, this study identifies novel cytokine patterns over time that may indicate impending DCI.