Adrenomedullin concentration in the cerebrospinal fluid is related to appetite loss and delayed ischemic neurological deficits after subarachnoid hemorrhage

Abstract

Objective: Adrenomedullin (AM) is secreted into the cerebrospinal fluid (CSF) from the choroid plexus and regulates appetite. Adrenomedullin concentration in the CSF is elevated 7–10 days after the onset of aneurysmal subarachnoid hemorrhage (SAH). The aim of the present study was to determine whether CSF AM concentration is related to appetite and delayed ischemic neurological deficits (DIND) after SAH.Methods: Adrenomedullin concentration in the CSF, blood plasma profile, and appetite status were measured in 22 patients with SAH who underwent aneurysmal clipping within 48 hours of SAH onset. Appetite status was measured using dietary oral calorie intake and self-reported appetite level. All outcome variables were measured at an early (Day 3) and late (Day 8) time point after SAH onset (Day 0).Results: Dietary oral calorie intake (P = 0·02), self-reported appetite level (P = 0·03), hemoglobin (P = 0·01), albumin (P = 0·03), glucose (P = 0·01), and insulin (P = 0·03) levels were lower at the late time point than at the early time point. Cerebrospinal fluid adrenomedullin concentration was higher at the late time point than at the early time point (P = 0·0007). There was a significant negative correlation between AM concentration and dietary oral calorie intake (r = −0·478, P = 0·024) and self-reported appetite level (r = −0·454, P = 0·033) at the late time point. Six patients (27%) developed DIND. Adrenomedullin concentration at the late time point was significantly higher in patients who developed DIND than in patients who did not (P = 0·02).Conclusions: Cerebrospinal fluid adrenomedullin concentration 8 days after SAH onset is related to appetite loss and DIND.