The impact of nonsteroidal anti-inflammatory drugs on inflammatory response after aneurysmal subarachnoid hemorrhage.
BACKGROUND
The degree of inflammatory response with cytokine release is associated with poor outcomes after aneurysmal subarachnoid hemorrhage (SAH). Previously, we reported on an association between systemic IL-6 levels and clinical outcome in patients with aneurysmal SAH. The intention was to assess the impact of nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen on the inflammatory response after SAH.


METHODS
Our method involved exploratory analysis of data and samples collected within a previous study. In 138 patients with SAH, systemic interleukin (IL-6) and c-reactive protein (CRP) were measured daily up to day 14 after SAH. The correlations among the cumulatively applied amount of NSAIDs, inflammatory parameters, and clinical outcome were calculated.


RESULTS
An inverse correlation between cumulatively applied NSAIDs and both IL-6 and CRP levels was found (r = -0.437, p < 0.001 and r = -0.369, p < 0.001 respectively). Multivariable linear regression analysis showed a cumulative amount of NSAIDs to be independently predictive for systemic IL-6 and CRP levels. The cumulative amount of NSAIDs reduced the odds for unfavorable outcome, defined as Glasgow outcome scale 1-3.


CONCLUSIONS
The results indicate a potential beneficial effect of NSAIDs in patients with SAH in terms of ameliorating inflammatory response, which might have an impact on outcome.
Neurocritical Care Unit, Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland, carl.muroi@gmail.com.
Carl
C
Muroi
Michael
M
Hugelshofer
Martin
M
Seule
Emanuela
E
Keller
D000082:Acetaminophen / Q000008:administration & dosage / Q000494:pharmacology*; D000328:Adult; D000368:Aged; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000494:pharmacology*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000494:pharmacology*; D002097:C-Reactive Protein / Q000032:analysis; D004008:Diclofenac / Q000008:administration & dosage / Q000494:pharmacology; D004177:Dipyrone / Q000008:administration & dosage / Q000493:pharmacokinetics; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D007036:Hypothermia, Induced / Q000706:statistics & numerical data; D007052:Ibuprofen / Q000008:administration & dosage / Q000494:pharmacology; D007249:Inflammation / Q000188:drug therapy / Q000276:immunology; D015850:Interleukin-6 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000097:blood / Q000188:drug therapy* / Q000276:immunology*; D016896:Treatment Outcome
D018712:Analgesics, Non-Narcotic; D000894:Anti-Inflammatory Agents, Non-Steroidal; D015850:Interleukin-6; D004008:Diclofenac; D000082:Acetaminophen; D004177:Dipyrone; D002097:C-Reactive Protein; D007052:Ibuprofen