Body mass index and leptin levels in serum and cerebrospinal fluid in relation to delayed cerebral ischemia and outcome after aneurysmal subarachnoid hemorrhage

Michael Veldeman, Miriam Weiss, Tim Philipp Simon, Anke Hoellig, Hans Clusmann, Walid Albanna, Michael Veldeman, Miriam Weiss, Tim Philipp Simon, Anke Hoellig, Hans Clusmann, Walid Albanna

Abstract

Aneurysmal subarachnoid hemorrhage (SAH) is associated with a high mortality rate and may leave surviving patients severely disabled. After the initial hemorrhage, clinical outcome is further compromised by the occurrence of delayed cerebral ischemia (DCI). Overweight and obesity have previously been associated with protective effects in the post-bleeding phase. The aim of this study was to assess the effects of a patient's body mass index (BMI) and leptin levels on the occurrence of DCI, DCI-related cerebral infarction, and clinical outcome. In total, 263 SAH patients were included of which leptin levels were assessed in 24 cases. BMI was recorded along disease severity documented by the Hunt and Hess and modified Fisher scales. The occurrence of clinical or functional DCI (neuromonitoring, CT Perfusion) was assessed. Long-term clinical outcome was documented after 12 months (extended Glasgow outcome scale). A total of 136 (51.7%) patients developed DCI of which 72 (27.4%) developed DCI-related cerebral infarctions. No association between BMI and DCI occurrence (P = .410) or better clinical outcome (P = .643) was identified. Early leptin concentration in serum (P = .258) and CSF (P = .159) showed no predictive value in identifying patients at risk of unfavorable outcomes. However, a significant increase of leptin levels in CSF occurred from 326.0 pg/ml IQR 171.9 prior to DCI development to 579.2 pg/ml IQR 211.9 during ongoing DCI (P = .049). In our data, no association between obesity and clinical outcome was detected. After DCI development, leptin levels in CSF increased either by an upsurge of active transport or disruption of the blood-CSF barrier. This trial has been registered at ClinicalTrials.gov (NCT02142166) as part of a larger-scale prospective data collection. BioSAB: https://ichgcp.net/clinical-trials-registry/NCT02142166.

Keywords: Body mass index; Delayed cerebral ischemia; Fat metabolism; Leptin; Subarachnoid hemorrhage.

Conflict of interest statement

The authors declare no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Flowchart of patient recruitment. BMI was categorized according the WHO criteria with the addition of an obesity subdivision resulting in five categories: underweight (2), normal weight (≥ 18.5 to < 25 kg/m2), overweight (≥ 25 to < 30 kg/m2), obesity grade 1 (≥ 30 to < 35 kg/m2), and obesity grade 2 (≥ 35 kg/m2). SAH, subarachnoid hemorrhage
Fig. 2
Fig. 2
Comparison of leptin levels in serum (a) and CSF (b) before and after the occurrence of DCI (n = 14). As pre-DCI, leptin measurements available between 2 and 4 days prior to the initial DCI diagnosis were used. A statistically significant increase of leptin levels in CSF from 326.0 pg/ml IQR 171.90 to 579.2 pg/ml IQR 211.9 (P = .049) was observed. CSF, cerebrospinal fluid; DCI, delayed cerebral ischemia; pre-DCI, measurement 2–4 days prior to DCI diagnosis

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