Cerebral inflammatory response and predictors of admission clinical grade after aneurysmal subarachnoid hemorrhage

Khalid A. Hanafy, R. Morgan Stuart, Luis Fernandez, J. Michael Schmidt, Jan Claassen, Kiwon Lee, E. Sander Connolly, Stephan A. Mayer, Neeraj Badjatia

Research output: Contribution to journalArticlepeer-review

30 Scopus citations

Abstract

Poor admission clinical grade is the most important determinant of outcome after aneurysmal subarachnoid hemorrhage (aSAH); however, little attention has been focused on independent predictors of poor admission clinical grade. We hypothesized that the cerebral inflammatory response initiated at the time of aneurysm rupture contributes to ultra-early brain injury and poor admission clinical grade. We sought to identify factors known to contribute to cerebral inflammation as well as markers of cerebral dysfunction that were associated with poor admission clinical grade. Between 1997 and 2008, 850 consecutive SAH patients were enrolled in our prospective database. Demographic data, physiological parameters, and location and volume of blood were recorded. After univariate analysis, significant variables were entered into a logistic regression model to identify significant associations with poor admission clinical grade (Hunt-Hess grade 4-5). Independent predictors of poor admission grade included a SAH sum score >15/30 (odds ratio [OR] 2.3, 95% confidence interval [CI] 1.5-3.6), an intraventricular hemorrhage sum score >1/12 (OR 3.1, 95% CI 2.1-4.8), aneurysm size >10 mm (OR 1.7, 95% CI 1.1-2.6), body temperature ≥38.3 °C (OR 2.5, 95% CI 1.1-5.4), and hyperglycemia >200 mg/dL (OR 2.7, 95% CI 1.6-4.5). In a large, consecutive series of prospectively enrolled patients with SAH, the inflammatory response at the time of aneurysm rupture, as reflected by the volume and location of the hemoglobin burden, hyperthermia, and perturbed glucose metabolism, independently predicts poor admission Hunt-Hess grade. Strategies for mitigating the inflammatory response to aneurysmal rupture in the hyper-acute setting may improve the admission clinical grade, which may in turn improve outcomes.

Original languageEnglish
Pages (from-to)22-25
Number of pages4
JournalJournal of Clinical Neuroscience
Volume17
Issue number1
DOIs
StatePublished - Jan 2010
Externally publishedYes

Keywords

  • Clinical grade
  • Early brain injury
  • Fever
  • Hyperglycemia
  • Inflammation
  • Neuro-intensive care unit
  • Subarachnoid hemorrhage
  • Subarachnoid hemorrhage sum score

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