title: Cerebral inflammatory response and predictors of admission clinical grade after aneurysmal subarachnoid hemorrhage.
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 >10mm (OR 1.7, 95% CI 1.1-2.6), body temperature 38.3 degrees C (OR 2.5, 95% CI 1.1-5.4), and hyperglycemia >200mg/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.
authors.affiliation: Department of Neurology, Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA. kh2401@columbia.edu
authors.forename: Khalid A
authors.initials: KA
authors.lastname: Hanafy
authors.forename: R
authors.initials: R
authors.lastname: Morgan Stuart
authors.forename: Luis
authors.initials: L
authors.lastname: Fernandez
authors.forename: J Michael
authors.initials: JM
authors.lastname: Schmidt
authors.forename: Jan
authors.initials: J
authors.lastname: Claassen
authors.forename: Kiwon
authors.initials: K
authors.lastname: Lee
authors.forename: E
authors.initials: E
authors.lastname: Sander Connolly
authors.forename: Stephan A
authors.initials: SA
authors.lastname: Mayer
authors.forename: Neeraj
authors.initials: N
authors.lastname: Badjatia
mesh_terms: D000328:Adult; D001928:Brain Diseases, Metabolic / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology*; D003955:Diagnostic Tests, Routine / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D018450:Disease Progression; D042241:Early Diagnosis; D004632:Emergency Medical Services / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D004660:Encephalitis / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology*; D005260:Female; D005334:Fever / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D005947:Glucose / Q000378:metabolism; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000503:physiopathology*; D013997:Time Factors
chemical_list: D005947:Glucose