Sympathetic activation and inflammatory response in patients with subarachnoid haemorrhage.
OBJECTIVE
The aim of this study was to evaluate the correlation between sympathetic nervous activation and the immune response in patients following subarachnoid haemorrhage (SAH).


METHODS
Clinical study in a neurosurgical intensive care unit.


METHODS
Fourteen patients with acute non-traumatic SAH were included. Fifteen healthy, age-matched volunteers served as controls for measurement of catecholamine spillover.


METHODS
Blood sampling for C3a, C5b-9, IL-6, IL-8 and norepinephrine kinetic determination was made within 48 h, at 72 h and on the 7th-10th day after the SAH.


RESULTS
SAH patients exhibited a profound increase in the rate of norepinephrine spillover to plasma at 48 h, 72 h and 7-10 days after the insult, 3-4 times that in healthy individuals. The plasma levels of C3a, IL-6 and C5b-9 were significantly elevated at 48 h, at 72 h and 7-10 days after the SAH, but the plasma level of IL-6 decreased significantly 7-10 days after the SAH. There was no relationship between the magnitude of sympathetic activation and the levels of inflammatory markers.


CONCLUSIONS
Following SAH a pronounced activation of the sympathetic nervous system and the inflammatory system occurs. The lack of significant association between the rate of spillover of norepinephrine to plasma and the plasma levels of inflammatory markers indicates that the two processes, sympathetic activation and the immune response, following SAH are not quantitatively linked. In spite of a persistent high level of sympathetic activation the plasma level of IL-6 decreased significantly one week after SAH.
Naredi
Silvana
S
Department of Anaesthesiology and Intensive Care, Umeå University Hospital, Umeå, Sweden. silvana.naredi@anestesi.umu.se
Lambert
Gavin
G
Friberg
Peter
P
Zäll
Stefan
S
Edén
Elisabeth
E
Rydenhag
Bertil
B
Tylman
Maria
M
Bengtsson
Anders
A
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D016207:Cytokines / Q000097:blood*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood*; D013345:Subarachnoid Hemorrhage / Q000097:blood* / Q000276:immunology; D013564:Sympathetic Nervous System / Q000276:immunology / Q000378:metabolism
D016207:Cytokines; D009638:Norepinephrine