Early elevation of serum tumor necrosis factor-α is associated with poor outcome in subarachnoid hemorrhage.
OBJECTIVE
Subarachnoid hemorrhage (SAH) is associated with inflammation that may mediate poor outcome in SAH. We hypothesize that elevated serum tumor necrosis factor α (TNF-α) and interleukin 6 (IL-6) are associated with vasospasm and poor outcome in SAH.


METHODS
In 52 consecutive SAH subjects, we compared TNF-α and IL-6 levels on post-SAH days 0 to 1, 2 to 3, 4 to 5, 6 to 8, and 10 to 14 with respect to vasospasm and to poor outcome at 3 and 6 months. Vasospasm was defined as more than 50% reduction in vessel caliber on angiography. Poor outcome was defined as modified Rankin score greater than 2.


RESULTS
Elevated TNF-α on post-SAH days 2 to 3 was associated with poor 3-month outcome (P = 0.0004). Global elevation of TNF-α over time (post-SAH days 0-14) was independently associated with poor 3-month outcome after adjusting for Hunt-and-Hess grade and age (P = 0.02). Neither cross-sectional nor IL-6 levels over time were associated with outcome. Neither TNF-α nor IL-6 levels were associated with vasospasm.


CONCLUSIONS
Elevation in serum TNF-α on post-SAH days 2 to 3 and global elevation of TNF-α over time are associated with poor outcome but not with angiographic vasospasm in this small cohort. Future studies are needed to define the role of TNF-α in SAH-related brain injury and its potential as a SAH outcome biomarker.
Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02114, USA.
Sherry H-Y
SH
Chou
Steven K
SK
Feske
Juli
J
Atherton
Rachael G
RG
Konigsberg
Philip L
PL
De Jager
Rose
R
Du
Christopher S
CS
Ogilvy
Eng H
EH
Lo
MingMing
M
Ning
D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013345:Subarachnoid Hemorrhage / Q000097:blood*; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*
D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha