Pesaresi Alessandro, Battaglini Denise, Anania Pasquale, Sgambetterra Silvia, Origlia Camilla, Zona Gianluigi, Langer Thomas, Patroniti Nicolò Antonino, Fiaschi Pietro, Robba Chiara
Division of Neurosurgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
Neurosurgery Unit, "Città Della Salute E Della Scienza" University Hospital, Turin, Italy.
J Anesth Analg Crit Care. 2025 Jun 12;5(1):31. doi: 10.1186/s44158-025-00250-1.
Changes in cerebrospinal fluid (CSF) in patients with aneurysmal subarachnoid hemorrhage (aSAH) have not been fully elucidated, yet they are critical and may potentially be associated with the risk of complications. The aim of this study is to characterize the biochemical properties of CSF and examine the temporal changes in aSAH patients with and without post-aSAH complications such as vasospasm and shunt-dependent hydrocephalus.
This prospective observational longitudinal cohort study involved collecting CSF and arterial blood samples from SAH patients requiring an external ventricular drain at four different timepoints following the initial event (1-3, 4-7, 8-13, and 14-20 days after aSAH). A control group that comprised patients with idiopathic normal pressure hydrocephalus undergoing CSF sampling was included.
A total of 20 SAH patients and 20 controls were enrolled. We observed significantly higher levels of hemoglobin (Hb), proteins, lactate, and cell concentrations in the CSF of aSAH patients compared to the control group (p < 0.001), with no corresponding differences in serum levels. Furthermore, a progressive decline in CSF Hb, proteins, and cells levels was noted over the days following the hemorrhage (p = 0.029, p = 0.005, and p = 0.010, respectively). Patients that developed vasospasm exhibited a lower CSF glucose/lactate ratio (p < 0.001) and reduced CSF sodium levels (p = 0.045), while patients that developed shunt-dependent hydrocephalus exhibited higher plasmatic and CSF glucose levels (p = 0.013 and p = 0.003, respectively) and lower CSF Hb/proteins ratio (p < 0.001).
Patients with aSAH exhibit changes in the biochemical profile of the CSF, which evolve over time following the acute event. Parameters such as CSF glucose/lactate ratio and CSF Hb/proteins ratio could potentially provide valuable insights not only into the pathophysiology of aSAH but also into patient risks of post-hemorrhagic complications, such as vasospasm and hydrocephalus.
动脉瘤性蛛网膜下腔出血（aSAH）患者脑脊液（CSF）的变化尚未完全阐明，但这些变化至关重要，可能与并发症风险相关。本研究的目的是描述CSF的生化特性，并研究有和没有aSAH后并发症（如血管痉挛和分流依赖性脑积水）的aSAH患者的时间变化。
这项前瞻性观察性纵向队列研究包括在初始事件后的四个不同时间点（aSAH后1 - 3天、4 - 7天、8 - 13天和14 - 20天）从需要进行外部脑室引流的SAH患者中采集CSF和动脉血样本。纳入了一个由接受CSF采样的特发性正常压力脑积水患者组成的对照组。
共纳入20例SAH患者和20例对照。我们观察到，与对照组相比，aSAH患者CSF中的血红蛋白（Hb）、蛋白质、乳酸和细胞浓度显著更高（p < 0.001），血清水平无相应差异。此外，出血后的几天内，CSF中的Hb、蛋白质和细胞水平逐渐下降（分别为p = 0.029、p = 0.005和p = 0.010）。发生血管痉挛的患者CSF葡萄糖/乳酸比值较低（p < 0.001）且CSF钠水平降低（p = 0.045），而发生分流依赖性脑积水的患者血浆和CSF葡萄糖水平较高（分别为p = 0.013和p = 0.003）且CSF Hb/蛋白质比值较低（p < 0.001）。
aSAH患者的CSF生化特征会发生变化，这些变化在急性事件后随时间演变。CSF葡萄糖/乳酸比值和CSF Hb/蛋白质比值等参数不仅可能为aSAH的病理生理学提供有价值的见解，还可能为出血后并发症（如血管痉挛和脑积水）的患者风险提供有价值的见解。
