World neurosurgery · 2025
The Course and Clinical Relevance of Interleukin-6 in Cerebrospinal Fluid in Patients with Aneurysmal Subarachnoid Hemorrhage.
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Ketelauri Pikria, Gümüs Meltem, Gull Hanah Hadice, Rieß Christoph, Dinger Thiemo Florin, Li Yan, Rauschenbach Laurèl, Ahmadipour Yahya, Oppong Marvin Darkwah, Dammann Philipp, Wrede Karsten, Sure Ulrich, Jabbarli Ramazan
Аннотация
BACKGROUND: The neuroinflammatory response to aneurysmal subarachnoid hemorrhage (SAH) might have a crucial impact on the burden of disease. We aimed to analyze the behavior of interleukin-6 (IL-6) in cerebrospinal fluid (CSF) during SAH and its relation to complications and outcomes.
METHODS: We included consecutive SAH patients with regular CSF IL-6 measurements treated between January 2005 and June 2016 (n = 420). IL-6 levels were recorded every 72 hours (from day 1-3 [d1-3] until day 19-21 [d19-21]). Study endpoints were delayed cerebral infarction (DC-infarction), in-hospital mortality, and unfavorable outcome at 6 months after SAH (modified Rankin scale >3).
RESULTS: There was an initial increase of IL-6 on d4-6 (median: 3121 vs. 1467 pg/mL on d1-3), with a gradual decrease over the remaining time. The IL-6 value on d1-3 showed associations with in-hospital mortality and unfavorable outcomes, whereas IL-6 on d4-6 was related to the risk of DC-infarction and in-hospital mortality. According to receiver operating characteristic curves, clinically relevant cutoffs were defined for IL-6 on d1-3 (>2000 pg/mL) and d4-6 (>2500 pg/mL). In multivariate analysis, IL-6 >2000 pg/mL on d1-3 was independently associated with in-hospital mortality (adjusted odds ratio [aOR = 2.67; P = 0.009) and unfavorable outcome (aOR=2.30; P = 0.006). In turn, IL-6 >2500 pg/mL on d4-6 was independently associated with in-hospital mortality (aOR = 2.28; P = 0.017) and DC-infarction (aOR = 1.64; P = 0.044). SAH individuals with angiographic vasospasm showed marked elevation of IL-6 from d1-3 to d4-6 compared to their counterparts without vasospasm (+1770.5 vs. -21 pg/mL; P = 0.02).
CONCLUSIONS: Our data confirm the substantial impact of neuroinflammation on SAH. CSF IL-6 values measured during the first week after SAH occurrence present the most valuable outcome predictors.
METHODS: We included consecutive SAH patients with regular CSF IL-6 measurements treated between January 2005 and June 2016 (n = 420). IL-6 levels were recorded every 72 hours (from day 1-3 [d1-3] until day 19-21 [d19-21]). Study endpoints were delayed cerebral infarction (DC-infarction), in-hospital mortality, and unfavorable outcome at 6 months after SAH (modified Rankin scale >3).
RESULTS: There was an initial increase of IL-6 on d4-6 (median: 3121 vs. 1467 pg/mL on d1-3), with a gradual decrease over the remaining time. The IL-6 value on d1-3 showed associations with in-hospital mortality and unfavorable outcomes, whereas IL-6 on d4-6 was related to the risk of DC-infarction and in-hospital mortality. According to receiver operating characteristic curves, clinically relevant cutoffs were defined for IL-6 on d1-3 (>2000 pg/mL) and d4-6 (>2500 pg/mL). In multivariate analysis, IL-6 >2000 pg/mL on d1-3 was independently associated with in-hospital mortality (adjusted odds ratio [aOR = 2.67; P = 0.009) and unfavorable outcome (aOR=2.30; P = 0.006). In turn, IL-6 >2500 pg/mL on d4-6 was independently associated with in-hospital mortality (aOR = 2.28; P = 0.017) and DC-infarction (aOR = 1.64; P = 0.044). SAH individuals with angiographic vasospasm showed marked elevation of IL-6 from d1-3 to d4-6 compared to their counterparts without vasospasm (+1770.5 vs. -21 pg/mL; P = 0.02).
CONCLUSIONS: Our data confirm the substantial impact of neuroinflammation on SAH. CSF IL-6 values measured during the first week after SAH occurrence present the most valuable outcome predictors.