Interleukin 6 in the Cerebrospinal Fluid as a Biomarker for Onset of Vasospasm and Ventriculitis After Severe Subarachnoid Hemorrhage.

Abstract

The aim of the study was to investigate the diagnostic potential of interleukin 6 (IL-6) and other soluble biomarkers in serum and cerebrospinal fluid (CSF) for early diagnosis of cerebral vasospasm (cVS_SAH) and external ventricular drain-associated ventriculitis (VC_SAH) and to separate these conditions from aneurysmal subarachnoid hemorrhage (aSAH) without further complication (SAH^w/o/c). The concentrations of serum biomarkers and markers in the CSF were collected in 63 consecutive patients with aSAH and external ventricular drainage. Arithmetical means and standard deviations, area under the curve (AUC), cutoff values (C-OFF), sensitivity (SE), and specificity (SP) were calculated for markers and their correlation with SAH^w/o/c, cVS_SAH, and VC_SAH. Clinical courses included 27 patients with cVS_SAH, 17 with VC_SAH, and 19 with SAH^w/o/c. Mean ± standard deviation_CSFIL-6 values were 7588 ± 4580 pg/mL at onset of VC_SAH and 4102 ± 4970 pg/mL for cVS_SAH and higher than 234 ± 239 pg/mL in SAH^w/o/c (P < 0.001). _CSFIL-6 showed excellent diagnostic potential for differing between VC_SAH and SAH^w/o/c (AUC, 1.00; C-OFF, 707; SE, 100%; SP, 100%), and a moderate diagnostic potential for differing VC_SAH from cVS_SAH (AUC, 0.757; C-OFF, 3100 pg/Ml; SE, 86.7%; SP, 70.6%). The concentration of _CSFIL-6 within the cVS_SAH group was significantly increased compared with SAH^w/o/c (AUC, 0.937; C-OFF, 530 pg/mL; SE, 87.5%; SP, 91.7%). _CSFIL-6 is increased after aSAH in patients with cVS_SAH or VC_SAH. Patients with a _CSFIL-6 level higher than a C-OFF of 3100 pg/mL have an increased likelihood for VC_SAH; patients with _CSFIL-6 levels between 530 and 3100 pg/mL have an increased posttest probability for cVS_SAH.