CSF inflammatory response after intraventricular hemorrhage
Maged D Fam, Hussein A Zeineddine, Javed Khader Eliyas, Agnieszka Stadnik, Michael Jesselson, Nichol McBee, Karen Lane, Ying Cao, Meijing Wu, Lingjiao Zhang, Richard E Thompson, Sayona John, Wendy Ziai, Daniel F Hanley, Issam A Awad, CLEAR III Trial Investigators, Harold Adams, Opeolu Adeoye, Sachin Agarwal, Maria Aguilar, E Francois Aldrich, Safdar Ansari, David Antezana, Agnieszka Ardelt, Fuat Arikan, Pal Barzo, Peter Bazso, Julian Bösel, Mel Boulton, Diederik Bulters, Ken Butcher, Paul Camarata, Jean-Louis Caron, Kevin Cockroft, Mauricio Concha, H Mark Crabtree, Salvador Cruz-Flores, Laszlo Csiba, David Decker, Alberto Torres Díaz, Benjamin Emanuel, William Freeman, Michael Froehler, Latorre Julius Gen, Martin Gizzi, Nicole Gonzales, R Scott Graham, David Greer, Christiana Hall, Sagi Harnof, Mark Harrigan, Ann Helms, Alan Hoffer, James Holsapple, Hagen Huttner, Michael Jacoby, Jack Jallo, Michael Luke James, Eric Juttler, Marcelo Kern, Thomas Kerz, Inam Kureshi, Christos Lazaridis, David LeDoux, Jody Leonardo, Alexandre Luiz Longo, George Lopez, Darren Lovick, Andreas Luft, Jorge Marconde de Souza, Nevo Margalit, Mason Markowski, Joan Marti-Fabregas, Sheila Cristina Ouriques Martins, A D Mendelow, Dominik Michalski, Thomas Mirsen, Asma Moheet, David Newell, George Newman, Christopher Ogilvy, Hiren Patel, Pedro Telles Cougo Pinto, Sven Poli, Michael Reinert, Guy Rosenthal, Fernando Santiago, Michael Schneck, David B Seder, Qaisar A Shah, Kavian Shahi, Gisele Sampaio Silva, David Sinclair, Laszlo Szapary, Ashis H Tayal, Fernando Testai, Michel Torbey, Kristi Tucker, Stanley Tuhrim, Igor Ugorec, Panayiotis Varelas, Chitra Venkatasubramanian, Paul Vespa, Katja Wartenberg, Michael Weaver, Lawrence Wechsler, Menashe Zaaroor, Maged D Fam, Hussein A Zeineddine, Javed Khader Eliyas, Agnieszka Stadnik, Michael Jesselson, Nichol McBee, Karen Lane, Ying Cao, Meijing Wu, Lingjiao Zhang, Richard E Thompson, Sayona John, Wendy Ziai, Daniel F Hanley, Issam A Awad, CLEAR III Trial Investigators, Harold Adams, Opeolu Adeoye, Sachin Agarwal, Maria Aguilar, E Francois Aldrich, Safdar Ansari, David Antezana, Agnieszka Ardelt, Fuat Arikan, Pal Barzo, Peter Bazso, Julian Bösel, Mel Boulton, Diederik Bulters, Ken Butcher, Paul Camarata, Jean-Louis Caron, Kevin Cockroft, Mauricio Concha, H Mark Crabtree, Salvador Cruz-Flores, Laszlo Csiba, David Decker, Alberto Torres Díaz, Benjamin Emanuel, William Freeman, Michael Froehler, Latorre Julius Gen, Martin Gizzi, Nicole Gonzales, R Scott Graham, David Greer, Christiana Hall, Sagi Harnof, Mark Harrigan, Ann Helms, Alan Hoffer, James Holsapple, Hagen Huttner, Michael Jacoby, Jack Jallo, Michael Luke James, Eric Juttler, Marcelo Kern, Thomas Kerz, Inam Kureshi, Christos Lazaridis, David LeDoux, Jody Leonardo, Alexandre Luiz Longo, George Lopez, Darren Lovick, Andreas Luft, Jorge Marconde de Souza, Nevo Margalit, Mason Markowski, Joan Marti-Fabregas, Sheila Cristina Ouriques Martins, A D Mendelow, Dominik Michalski, Thomas Mirsen, Asma Moheet, David Newell, George Newman, Christopher Ogilvy, Hiren Patel, Pedro Telles Cougo Pinto, Sven Poli, Michael Reinert, Guy Rosenthal, Fernando Santiago, Michael Schneck, David B Seder, Qaisar A Shah, Kavian Shahi, Gisele Sampaio Silva, David Sinclair, Laszlo Szapary, Ashis H Tayal, Fernando Testai, Michel Torbey, Kristi Tucker, Stanley Tuhrim, Igor Ugorec, Panayiotis Varelas, Chitra Venkatasubramanian, Paul Vespa, Katja Wartenberg, Michael Weaver, Lawrence Wechsler, Menashe Zaaroor
Abstract
Objective: To investigate the temporal pattern and relevant associations of CSF inflammatory measures after intraventricular hemorrhage (IVH).
Methods: We analyzed prospectively collected CSF cell counts and protein and glucose levels from participants in the Clot Lysis Evaluation of Accelerated Resolution of IVH phase III (CLEAR III) trial. Corrected leukocyte count and cell index were calculated to adjust for CSF leukocytes attributable to circulating blood. Data were chronologically plotted. CSF inflammatory measures (daily, mean, median, maximum, and cases with highest quartile response) were correlated with initial IVH volume, IVH clearance rate, thrombolytic treatment, bacterial infection, and adjudicated clinical outcome at 30 and 180 days.
Results: A total of 11,376 data points of CSF results from 464 trial participants were analyzed. Measures of CSF inflammatory response evolved during the resolution of IVH. This was significantly more pronounced with initial IVH volume exceeding 20 mL. Intraventricular alteplase was associated with a significantly augmented inflammatory response compared to saline, even after correcting for initial IVH volume. There was an association but nonpredictive correlation of CSF inflammation measures with culture-positive CSF bacterial infection. None of the CSF inflammatory measures, including cases with upper quartile inflammatory response, was associated with a significant detrimental effect on 30 or 180 days functional outcome or mortality after multivariate adjustment for measures of disease severity.
Conclusions: Aseptic CSF inflammation after IVH is primarily dependent on the volume of initial bleed. Thrombolysis intensifies the inflammatory response, with no apparent detrimental effect on clinical outcome.
Clinicaltrialsgov identifier: NCT00784134.
© 2017 American Academy of Neurology.
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Source: PubMed