Cerebrospinal fluid pentraxin 3 early after subarachnoid hemorrhage is associated with vasospasm

• Published in: Intensive care medicine Vol. 37; no. 2; pp. 302 - 309
• Main Authors: Zanier, Elisa R., Brandi, Giovanna, Peri, Giuseppe, Longhi, Luca, Zoerle, Tommaso, Tettamanti, Mauro, Garlanda, Cecilia, Sigurtà, Anna, Valaperta, Serenella, Mantovani, Alberto, De Simoni, Maria Grazia, Stocchetti, Nino
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01-02-2011; Springer; Springer Nature B.V
• Subjects: Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology; Aneurysms; Biological and medical sciences; Blood & organ donations; Brain research; C-Reactive Protein - cerebrospinal fluid; Cerebrospinal Fluid - metabolism; Critical Care; Critical Care Medicine; Early Diagnosis; Emergency and intensive postoperative care (general aspects). Pathophysiology of surgery; Emergency Medicine; Ethylenediaminetetraacetic acid; Female; Hemorrhage; Humans; Intensive; Intensive care; Intensive care medicine; Ischemia; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Original; Pain Medicine; Pediatrics; Plasma; Pneumology/Respiratory System; Serum Amyloid P-Component - cerebrospinal fluid; Subarachnoid hemorrhage; Subarachnoid Hemorrhage - blood; Subarachnoid Hemorrhage - cerebrospinal fluid; Subarachnoid Hemorrhage - complications; Vasospasm, Intracranial - blood; Vasospasm, Intracranial - cerebrospinal fluid; Vasospasm, Intracranial - complications; Vasospasm, Intracranial - diagnosis; Vasospasm, Intracranial - metabolism; Italy; Vasospasm; Inflammation; Pentraxin 3; Subarachnoid hemorrhage; Vasomotricity; Intensive care; Vasoconstriction; Cardiovascular disease; Cerebrospinal fluid; Resuscitation
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-010-2075-2

Purpose
To investigate plasma and cerebrospinal fluid (CSF) concentrations of pentraxin 3 (PTX3), a prototypic long pentraxin protein induced by proinflammatory signals, in subarachnoid hemorrhage (SAH), and its relation with SAH-associated vasospasm.
Methods
Serial plasma and CSF samples were collected from 38 consecutive SAH patients admitted to the Neurosurgical Intensive Care. PTX3 concentrations were analyzed in relation to clinical status and clinical vasospasm (defined as neuro-worsening and angiographic confirmation of vessel narrowing). Since neutrophils are an important source of preformed PTX3, myeloperoxidase (MPO) in CSF was measured to assess the correlation with CSF PTX3 and establish whether blood contamination was the determinant of PTX3 increase.
Results
PTX3 was elevated in all SAH patients both in plasma and CSF. Acute peak (first 48 h after SAH) CSF PTX3 was significantly higher in patients who later developed vasospasm [median 13.6 (range 2.3–51.9) ng/ml] compared to those who did not [3.2 (0.1–50.5) ng/ml,
p
 = 0.03]. The temporal pattern of CSF PTX3 in patients with vasospasm was triphasic with a peak during the first 48 h after SAH, a subsequent decrease in the following 48–96 h and a secondary significant increase with the occurrence of vasospasm. A loose correlation between CSF PTX3 and MPO was observed (
r
2
 = 0.13), indicating that following SAH there is a brain production of PTX3.
Conclusions
Acute increased concentrations of PTX3 in CSF but not in plasma are related to the occurrence of vasospasm, indicating that measurement of CSF PTX3 associated with the clinical evaluation can improve early diagnosis of this complication.