Cytokine markers in intracerebral hemorrhage are linked to ventricular imaging and outcomes.

OBJECTIVE

Central nervous system (CNS) inflammation after intracerebral hemorrhage (ICH) is substantial, but its relationship to radiographic severity and outcome remains unclear. Cerebrospinal fluid (CSF) obtained via external ventricular drains (EVDs) offers a direct window into CNS inflammation. We hypothesized that a stronger proinflammatory CSF cytokine response would be associated with ventricular enlargement and worse functional outcome.

METHODS

In this study, 56 ICH patients and 25 controls with normal pressure hydrocephalus were analyzed. CSF (days 0-16) and plasma (days 0-7) samples were. Concentrations of CC motif chemokine ligand 2 (CCL2), interleukin-6 (IL-6), interleukin-8 (IL-8), granulocyte colony-stimulating factor (G-CSF), and vascular endothelial growth factor A (VEGF-A) were measured. Ventricular volumes were derived from two computed tomography (CT) scans per patient (admission and EVD-clamp time point). Associations with ventricular volume change and 3-month modified Rankin Scale (mRS) were assessed using regression models.

RESULTS

Detectable CSF cytokines were elevated in ICH patients compared to control plasma (all p < 0.001), supporting compartmentalized CNS inflammation. Higher late CSF log[CCL2] was independently associated with greater ventricular enlargement (β = 33.41, 95% CI 7.22-59.60, p = 0.019; q = 0.034). Higher late CSF log[IL-6] (β=0.78, p = 0.011) and log[IL-8] (β=0.77, p = 0.009) remained independently associated with worse 3-month mRS.

CONCLUSIONS

CSF cytokines reflect the post-ICH central inflammatory response and are associated with ventricular enlargement and functional outcome, highlighting their potential as biomarkers of disease progression and therapeutic response post-ICH.