Determination of inflammatory mediator levels in cerebrospinal fluid during the formation of cerebral vasospasm and delayed cerebral ischemia after subarachnoid hemorrhage

Abstract

Introduction. Delayed cerebral ischemia (DCI) and cerebral vasospasm (CV) lead to poor outcomes in patients after aneurysmal subarachnoid hemorrhage (aSAH). The pathophysiology of these complications is not fully understood, preventing the adoption of a single definition. Reliable diagnostic tests and effective evidence-based treatment are lacking. Objective: to determine the relationship between the concentration of interleukin-6 (IL-6), IL-10, IL-17, tumor necrosis factor-α (TNF-α) in cerebrospinal fluid and formation of delayed complications of subarachnoid hemorrhage. Materials and methods. The study involved 45 patients with aSAH who were treated in Kharkiv Regional Hospital (18 men and 27 women aged 32 to 73 years (mean age ‒ 45.9±8.5 years). The control group consisted of 20 healthy individuals (8 men and 12 women aged from 32 to 73 years (mean age - 59.2±10.6 years). The occurrence of DCI or CV was recorded. The level of IL-6, IL-10, IL-17 and TNF-α in the cerebrospinal fluid (CSF) was measured in all subjects of the study using enzyme-linked immunosorbent assay. Results. Levels of IL-6, TNF-α, IL-17, and IL-10 in the CSF of patients with aSAH were higher than in control subjects. In patients with CV, the values of IL-6, IL-17 and TNF-α in CSF exceeded those of patients without CV. The concentration of IL-6 and TNF-α was also increased in the cerebrospinal fluid of patients with DCI. Conclusions. The obtained results indicate that IL-6 and TNF-α in CSF may be early markers for predicting vasospasm and DCI on the 3rd day after subarachnoid hemorrhage before clinical onset. The content of IL-17 correlates with the formation of cerebral vasospasm, but there is no connection between its level in the CSF and DCI. The concentration of IL-10 in the CSF on the 3rd day after aSAH had no prognostic value either for CV or for DCI formation.