Article
Altered CSF metabolomics after aneurysmal SAH and delayed cerebral ischemia
Liquor Metaboliten nach aneurysmatischer Subarachnoidalblutung und DCI/Vasospasmus
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Published: | May 8, 2019 |
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Objective: The aim of this study was to investigate metabolite levels in cerebrospinal fluid (CSF) after aneurysmal subarachnoid hemorrhage (aSAH) and their correlation with delayed cerebral ischemia (DCI).
Methods: Eighty CSF samples of 16 patients with treated intracranial aneurysms were analyzed. The study population included patients undergoing emergency endovascular/microsurgical treatment for ruptured intracranial aneurysm (n=8). Control samples were collected intraoperatively at the beginning of the elective aneurysm surgery (n=8). The CSF samples after aSAH were consecutively collected by way of external ventricular drain (EVD) placement/intraoperatively, 6 hours later, and daily thereafter (day 1-10). The endogenous metabolites were analyzed with a targeted quantitative and quality controlled metabolites approach using the AbsoluteIDQ® p180 Kit. The results were pooled in 3 groups (controls / aSAH without DCI / aSAH with DCI). The occurrence of DCI was defined as symptomatic vasospasm, infarction attributable to vasospasm, or moderate-to-severe arterial narrowing seen on digital subtraction angiography.
Results: Most amino acid (AA) levels were increased in the CSF of patients with DCI (n=4) compared to controls (n=8; p<0.05), but did not differ from aSAH patients without DCI (n=4). Only proline, asymmetric dimethylarginine and kynurenine were significantly elevated in patients with DCI (p<0.05). In addition, the tyrosine/phenylalanine ratio was significantly lower (p<0.05), while the kynurenine/tryptophan ratio was substantially higher in DCI when compared to controls and aSAH without DCI (p<0.05). Moreover, several phosphatidylcholines concentrations were increased after aSAH and were associated with DCI (p<0.05).
Conclusion: Numerous significantly altered CSF-metabolites/compounds were found in patients with DCI related to aSAH. Their value as potential predictors deserve further investigation.