Department of Neurosurgery, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany.
Department of Intensive Care and Intermediate Care, RWTH Aachen University, Aachen, Germany.
Neurosurg Rev. 2021 Dec;44(6):3547-3556. doi: 10.1007/s10143-021-01541-1. Epub 2021 Apr 17.
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://clinicaltrials.gov/ct2/show/NCT02142166.
颅内动脉瘤性蛛网膜下腔出血（SAH）的死亡率较高，幸存者可能会严重残疾。在初次出血后，迟发性脑缺血（DCI）的发生会进一步影响临床预后。超重和肥胖先前与出血后阶段的保护作用有关。本研究旨在评估患者的体重指数（BMI）和瘦素水平对 DCI、DCI 相关脑梗死和临床预后的影响。共纳入 263 例 SAH 患者，其中 24 例评估了瘦素水平。记录 BMI 以及 Hunt 和 Hess 和改良 Fisher 量表记录的疾病严重程度。评估了临床或功能性 DCI（神经监测、CT 灌注）的发生。12 个月后记录长期临床预后（扩展格拉斯哥预后量表）。共有 136 例（51.7%）患者发生 DCI，其中 72 例（27.4%）发生 DCI 相关脑梗死。BMI 与 DCI 发生（P=0.410）或更好的临床结局（P=0.643）之间无关联。血清（P=0.258）和 CSF（P=0.159）中瘦素浓度的早期变化在确定预后不良风险的患者方面没有预测价值。然而，在 DCI 发生时，CSF 中的瘦素水平从 DCI 发生前的 326.0 pg/ml IQR 171.9 显著增加到 579.2 pg/ml IQR 211.9（P=0.049）。在我们的数据中，肥胖与临床结局之间没有关联。在 DCI 发生后，CSF 中的瘦素水平增加可能是通过主动转运增加或血脑屏障破坏所致。该试验已在 ClinicalTrials.gov（NCT02142166）注册，作为更大规模前瞻性数据收集的一部分。BioSAB：https://clinicaltrials.gov/ct2/show/NCT02142166。
