title: Adrenomedullin concentration in the cerebrospinal fluid is related to appetite loss and delayed ischemic neurological deficits after subarachnoid hemorrhage.
abstract: OBJECTIVE
  Adrenomedullin (AM) is secreted into the cerebrospinal fluid (CSF) from the choroid plexus and regulates appetite. Adrenomedullin concentration in the CSF is elevated 7-10 days after the onset of aneurysmal subarachnoid hemorrhage (SAH). The aim of the present study was to determine whether CSF AM concentration is related to appetite and delayed ischemic neurological deficits (DIND) after SAH.
  
  
  METHODS
  Adrenomedullin concentration in the CSF, blood plasma profile, and appetite status were measured in 22 patients with SAH who underwent aneurysmal clipping within 48 hours of SAH onset. Appetite status was measured using dietary oral calorie intake and self-reported appetite level. All outcome variables were measured at an early (Day 3) and late (Day 8) time point after SAH onset (Day 0).
  
  
  RESULTS
  Dietary oral calorie intake (P = 0·02), self-reported appetite level (P = 0·03), hemoglobin (P = 0·01), albumin (P = 0·03), glucose (P = 0·01), and insulin (P = 0·03) levels were lower at the late time point than at the early time point. Cerebrospinal fluid adrenomedullin concentration was higher at the late time point than at the early time point (P = 0·0007). There was a significant negative correlation between AM concentration and dietary oral calorie intake (r = -0·478, P = 0·024) and self-reported appetite level (r = -0·454, P = 0·033) at the late time point. Six patients (27%) developed DIND. Adrenomedullin concentration at the late time point was significantly higher in patients who developed DIND than in patients who did not (P = 0·02).
  
  
  CONCLUSIONS
  Cerebrospinal fluid adrenomedullin concentration 8 days after SAH onset is related to appetite loss and DIND.
authors.affiliation: Iwate Medical University, Morioka, Japan.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Kubo
authors.forename: Takahiro
authors.initials: T
authors.lastname: Koji
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kashimura
authors.forename: Yasunari
authors.initials: Y
authors.lastname: Otawara
authors.forename: Akira
authors.initials: A
authors.lastname: Ogawa
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Ogasawara
mesh_terms: D053607:Adrenomedullin / Q000134:cerebrospinal fluid*; D001066:Appetite / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology; D013345:Subarachnoid Hemorrhage / Q000134:cerebrospinal fluid* / Q000150:complications
chemical_list: D053607:Adrenomedullin