Periodontal Bacteria and Outcomes Following Aneurysmal Subarachnoid Hemorrhage: A Prospective Observational Analysis.

Background

Periodontitis has been associated with systemic diseases such as cerebrovascular events. Emerging research highlights the potential role of the microbiome in intracranial aneurysm formation and rupture. Aims: We aimed to explore the associations among periodontal pathogens and the outcomes in patients with aneurysmal subarachnoid hemorrhage (aSAH). Materials and

Methods

A total of 43 aSAH patients were enrolled. Clinical probing depth measurement and microbiological culture were performed for all participants. The markers of systemic immune response (IL-6, hsCRP) and brain injury (NSE, S100B) were measured between 24 and 48 h after admission. Development of delayed cerebral ischemia (DCI) as the primary and clinical outcome, based on modified Rankin Scale as secondary endpoints, comprised the chosen metrics.

Results

A significant association was observed between patients with periodontal pocket depth PPD ≥ 5 mm (n = 28) and DCI, which developed in 19 patients (p = 0.007). In the subgroup of patients with PPD ≥ 5 mm significant associations were found between certain periodontal pathogens and DCI. Higher hsCRP (p = 0.05), IL-6 (p = 0.037) levels were observed in cases with periodontal pathogens, independent of the depth of the pocket, suggesting systemic inflammation.

Conclusions

Elevated hsCRP and IL-6 levels, periodontal pocket depth ≥ 5 mm, and red-complex periodontal pathogens are associated with an increased risk of DCI after aSAH, suggesting a role for periodontal disease-related systemic inflammation in DCI risk stratification.