Cell-Free Oxyhemoglobin in Cerebrospinal Fluid After Aneurysmal Subarachnoid Hemorrhage: Biomarker and Potential Therapeutic Target

• Published in: World neurosurgery 2018-12, Vol.120, p.e660-e666
• Main Authors: Hugelshofer, Michael, Sikorski, Christopher M., Seule, Martin, Deuel, Jeremy, Muroi, Carl I., Seboek, Martina, Akeret, Kevin, Buzzi, Raphael, Regli, Luca, Schaer, Dominik J., Keller, Emanuela
• Format: Article
• Language: English
• Subjects: Adult; Aneurysm; Aneurysm, Ruptured - cerebrospinal fluid; Aneurysm, Ruptured - diagnostic imaging; Aneurysm, Ruptured - therapy; Biomarkers; Biomarkers - cerebrospinal fluid; Brain - diagnostic imaging; Brain Ischemia - cerebrospinal fluid; Brain Ischemia - diagnostic imaging; Brain Ischemia - therapy; Delayed ischemic neurologic deficits; Female; Hemoglobin; Humans; Intracranial Aneurysm - cerebrospinal fluid; Intracranial Aneurysm - diagnostic imaging; Intracranial Aneurysm - therapy; Intracranial hemorrhage; Male; Middle Aged; Oxyhemoglobins - cerebrospinal fluid; Subarachnoid hemorrhage; Subarachnoid Hemorrhage - cerebrospinal fluid; Subarachnoid Hemorrhage - diagnostic imaging; Subarachnoid Hemorrhage - therapy
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.08.141

Aneurysmal subarachnoid hemorrhage (aSAH) is often complicated by the occurrence of delayed ischemic neurologic deficits (DIND), which impairs the clinical outcome of patients. The release of oxyhemoglobin (oxyHb) from lysing erythrocytes into cerebrospinal fluid (CSF) may critically contribute to the development of DIND. Ventricular CSF of 18 high-grade (Fisher 3 and 4) aSAH patients was sampled daily from external ventricular drains between days 0 and 14 after bleeding. CSF was spectrophotometrically analyzed with precise quantification of cell-free oxyHb levels. OxyHb levels in CSF showed a delayed peak reaching the highest levels in the high-risk period for developing of DIND between days 3 and 14 after aneurysm rupture. Patients with DIND had a significantly higher cumulative oxyHb exposure within the first week after bleeding. OxyHb levels in CSF may be useful as a biomarker to predict DIND in aSAH patients. The contribution of oxyHb in CSF to the pathogenesis of DIND should be further investigated as a potential therapeutic target. •Oxyhemoglobin levels in CSF peak in the high-risk period for developing of DIND in aSAH patients.•Increased oxyhemoglobin levels precede secondary clinical deterioration in patients with DIND.•Patients with DIND had a significantly higher cumulative oxyHb exposure.