Correlation Among Systemic Inflammatory Parameter, Occurrence of Delayed Neurological Deficits, and Outcome After Aneurysmal Subarachnoid Hemorrhage

Muroi, Carl; Hugelshofer, Michael; Seule, Martin; Tastan, Ilhan; Fujioka, Masayuki; Mishima, Kenichi; Keller, Emanuela

doi:10.1227/neu.0b013e31828048ce

Cited by 86 publications

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“…Linear regression analysis showed, that the amount of NSAIDs applied was predictive for lower IL-6 and CRP levels after adjustment for potentially confounding factors. These results are of interest, as high CRP and IL-6 levels in particular have been associated with worse neurological outcome in patients with SAH [3,5,21]. In the logistic regression analysis, the cumulative amount of NSAIDs reduced the odds for worse functional outcome.…”

Section: Discussionmentioning

confidence: 96%

“…The current study is an exploratory analysis of data and samples collected within a previous study [5]. In brief, the prospective observational study was carried out at a single academic tertiary care center during a 3-years period.…”

Section: Methodsmentioning

confidence: 99%

“…All patients were treated according to a standardized treatment protocol as previously described [5,[12][13][14]. In all patients, mean arterial blood pressure (MAP) was monitored by an arterial catheter.…”

Section: Methodsmentioning

confidence: 99%

“…Recently, we reported about a positive correlation between systemic IL-6 levels and poor outcome in patients with SAH [5]. Several drugs, including nonsteroidal anti-inflammatory drugs (NSAIDs), aimed at limiting the inflammatory response, have been experimentally validated, with varying levels of success [2,[6][7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

“…However, clinical studies specifically examining the effect of NSAIDs on inflammatory response and outcome after SAH are virtually nonexistent. The present study intended to elucidate the potential impact of NSAID applicationincluding acetaminophen-on inflammatory parameters -in particular IL-6 levels-in the acute phase after SAH [5].…”

Section: Introductionmentioning

confidence: 99%

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The Impact of Nonsteroidal Anti-inflammatory Drugs on Inflammatory Response After Aneurysmal Subarachnoid Hemorrhage

et al. 2013

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Background: The degree of inflammatory response with cytokine release is associated with poor outcomes after aneurysmal subarachnoid hemorrhage (SAH). Previously, we reported on an association between systemic IL-6 levels and clinical outcome in patients with aneurysmal SAH. The intention was to assess the impact of nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen on the inflammatory response after SAH. Methods: Our method involved exploratory analysis of data and samples collected within a previous study. In 138 patients with SAH, systemic interleukin (IL-6) and c-reactive protein (CRP) were measured daily up to day 14 after SAH. The correlations among the cumulatively applied amount of NSAIDs, inflammatory parameters, and clinical outcome were calculated. Results An inverse correlation between cumulatively applied NSAIDs and both IL-6 and CRP levels was found (r = -0.437, p < 0.001 and r = -0.369, p < 0.001 respectively). Multivariable linear regression analysis showed a cumulative amount of NSAIDs to be independently predictive for systemic IL-6 and CRP levels. The cumulative amount of NSAIDs reduced the odds for unfavorable out-come, defined as Glasgow outcome scale 1-3. Conclusions: The results indicate a potential beneficial effect of NSAIDs in patients with SAH in terms of ameliorating inflammatory response, which might have an impact on outcome. AbstractBackground The degree of inflammatory response with cytokine release is associated with poor outcome after

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Section: Discussionmentioning

confidence: 96%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Impact of Nonsteroidal Anti-inflammatory Drugs on Inflammatory Response After Aneurysmal Subarachnoid Hemorrhage

et al. 2013

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Aneurysmal Subarachnoid Hemorrhage

2011

Encyclopedia of Clinical Neuropsychology

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Aneurysmal subarachnoid hemorrhage (SAH) is a worldwide health burden with high fatality and permanent disability rates. The overall prognosis depends on the volume of the initial bleed, rebleeding, and degree of delayed cerebral ischemia (DCI). Cardiac manifestations and neurogenic pulmonary edema indicate the severity of SAH. The International Subarachnoid Aneurysm Trial (ISAT) reported a favorable neurological outcome with the endovascular coiling procedure compared with surgical clipping at the end of 1 year. The ISAT trial recruits were primarily neurologically good grade patients with smaller anterior circulation aneurysms, and therefore the results cannot be reliably extrapolated to larger aneurysms, posterior circulation aneurysms, patients presenting with complex aneurysm morphology, and poor neurological grades. The role of hypothermia is not proven to be neuroprotective according to a large randomized controlled trial, Intraoperative Hypothermia for Aneurysms Surgery Trial (IHAST II), which recruited patients with good neurological grades. Patients in this trial were subjected to slow cooling and inadequate cooling time and were rewarmed rapidly. This methodology would have reduced the beneficial effects of hypothermia. Adenosine is found to be beneficial for transient induced hypotension in 2 retrospective analyses, without increasing the risk for cardiac and neurological morbidity. The neurological benefit of pharmacological neuroprotection and neuromonitoring is not proven in patients undergoing clipping of aneurysms. DCI is an important cause of morbidity and mortality following SAH, and the pathophysiology is likely multifactorial and not yet understood. At present, oral nimodipine has an established role in the management of DCI, along with maintenance of euvolemia and induced hypertension. Following SAH, hypernatremia, although less common than hyponatremia, is a predictor of poor neurological outcome.Key Words: subarachnoid hemorrhage, intracranial aneurysm, delayed cerebral ischemia (J Neurosurg Anesthesiol 2015;27:222-240) SUBARACHNOID HEMORRHAGE (SAH) IS A WORLDWIDE HEALTH BURDEN WITH HIGH RATES OF FATALITY AND PERMANENT DISABILITYThe estimated worldwide incidence of SAH is 9/ 100,000 persons/y with regional variation. 1 One systematic review found the incidence to be lower in South and Central America (4.2/100,000 persons/y) and higher in Japan (22.7/100,000 persons/y) and Finland (19.7/100,000 persons/y). 1 Interestingly, the prevalence of intracranial aneurysm is not found to be higher in Japan or Finland, 2 but the risk for rupture is higher. 3 The incidence is also reported lower in China (2.0 //100,000 persons/y). 4 SAH accounts for only 5% of all strokes, 5 but it has high mortality and permanent disability rates. A retrospective cohort study in 2 large Norwegian populations between 1984 and 2007 reported a 30-day case fatality rate of 36%. 6 A nationwide Danish study reported a similar 30-day mortality at 38%. 7 World Health Organization Multinational Monitoring Trends...

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UniversitätsSpital Zürich: 80 years of neurosurgical patient care in Switzerland

et al. 2017

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BackgroundThe predecessor of today’s Department of Neurosurgery, UniversitätsSpital Zürich (USZ), was founded 80 years ago as the first independent Swiss clinic dedicated to neurosurgical patient care. On the occasion of this anniversary, we aimed to highlight the history of neurosurgery as a specialty at the USZ, and to put it into the historical context of Swiss and European Neurosurgery.MethodA literature review was conducted and we searched the archives of the USZ and the city of Zurich, as well as those of Swiss journals to extract relevant published articles, books, historical reports and pictures. The USZ Department of Medical History, the Museum of Medical History and the Swiss National Library were contacted to provide source material. To further verify the content, (emeritus) faculty from the USZ and external experts on the history of Swiss neurosurgery reviewed the manuscript.ResultsSurgeries of the head and spine had occasionally been conducted in Zurich by the general surgeons, Rudolf Ulrich Krönlein and Paul Clairmont, before an independent neurosurgical clinic was founded by Hugo Krayenbühl on 6 July 1937. This was the first Swiss department dedicated to neurosurgical patient care. Besides providing high-quality medicine for both the local and wider population, the department was chaired by eminent leaders of neurosurgery, who influenced the scientific and clinical neurosurgery of their time. As such, it has long been regarded as one of the top teaching and research hospitals in Switzerland and in Europe.ConclusionsOn the occasion of its 80th anniversary, we have performed an in-depth review of its development, successes and challenges, with a special focus on the early decades. Reflecting on the past, we have identified common denominators of success in neurosurgery that remain valid today.Electronic supplementary materialThe online version of this article (10.1007/s00701-017-3357-z) contains supplementary material, which is available to authorised users.

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Correlation Among Systemic Inflammatory Parameter, Occurrence of Delayed Neurological Deficits, and Outcome After Aneurysmal Subarachnoid Hemorrhage

Abstract: Higher IL-6 levels are associated with worse clinical outcome and the occurrence of DINDs. Because IL-6 levels were significantly elevated in the early phase, they might be a useful parameter to monitor.

Cited by 86 publications

References 29 publications

The Impact of Nonsteroidal Anti-inflammatory Drugs on Inflammatory Response After Aneurysmal Subarachnoid Hemorrhage

The Impact of Nonsteroidal Anti-inflammatory Drugs on Inflammatory Response After Aneurysmal Subarachnoid Hemorrhage

Aneurysmal Subarachnoid Hemorrhage

UniversitätsSpital Zürich: 80 years of neurosurgical patient care in Switzerland

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