title: Relation of serum TNF-α and TNF-α genotype with delayed cerebral ischemia and outcome in subarachnoid hemorrhage.
abstract: BACKGROUND
  The pathogenesis of delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) remains obscure. The authors assessed the relationship of tumor necrosis factor alpha (TNF-α) and TNF-α gene polymorphisms with occurrence of DCI and poor outcome at 3 months.
  
  
  METHODS
  Serum levels of TNF-α were measured every other day until discharge in 67 patients and the mean serum levels per patient during days 0-12 were dichotomized at the median value of the whole group. TNF-α genotyping was available in 31 patients and related to serum TNF-α by means of one-way ANOVA analysis. The authors calculated hazard ratio's (HR) with corresponding 95% confidence intervals (CI) for the association with DCI by means of Cox proportional hazard analysis and odds ratio's (OR) for the association with poor clinical outcome by means of logistic regression analysis. In both analyses the authors adjusted for sex, age, amount of blood, and clinical condition at admission. Leukocytes and CRP were investigated similarly for comparison.
  
  
  RESULTS
  For high-serum TNF-α levels during days 0-12 adjusted HR was 0.6 (95%CI: 0.1-2.4) for DCI and adjusted OR 2.0 (95%CI: 0.4-9.0) for clinical outcome. Serum TNF-α levels were 11.4 pg/ml for wildtype TNF-α genotype and 9.7 pg/ml for the non-wildtype TNF-α genotype (P = 0.15). For the non-wildtype TNF-α genotype the HR for DCI was 0.4 (95%CI: 0.1-2.6) and the OR for clinical outcome was 0.8 (95%CI: 0.1-4.0).
  
  
  CONCLUSIONS
  It is unlikely that serum TNF-α or TNF-α genotype play an important role in the occurrence of DCI after SAH.
authors.affiliation: Utrecht Stroke Center, Rudolf Magnus Institute of Neuroscience, Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Martine M A
authors.initials: MM
authors.lastname: Beeftink
authors.forename: Ynte M
authors.initials: YM
authors.lastname: Ruigrok
authors.forename: Gabriel J E
authors.initials: GJ
authors.lastname: Rinkel
authors.forename: Walter M
authors.initials: WM
authors.lastname: van den Bergh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000097:blood* / Q000235:genetics* / Q000401:mortality; D002097:C-Reactive Protein / Q000032:analysis; D016001:Confidence Intervals; D005260:Female; D056726:Genetic Association Studies; D005838:Genotype; D006801:Humans; D053208:Kaplan-Meier Estimate; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D011110:Polymorphism, Genetic / Q000235:genetics*; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D013345:Subarachnoid Hemorrhage / Q000097:blood* / Q000235:genetics* / Q000401:mortality; D014409:Tumor Necrosis Factor-alpha / Q000097:blood* / Q000235:genetics*
chemical_list: D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein