Body mass index and leptin levels in serum and cerebrospinal fluid in relation to delayed cerebral ischemia and outcome after aneurysmal subarachnoid hemorrhage

Michael Veldeman,Tim Philipp Simon,Hans Clusmann,Anke Hoellig,Walid Albanna,Miriam Weiss

doi:10.1007/s10143-021-01541-1

Michael Veldeman, Tim Philipp Simon + Show 4 more

Open Access

https://doi.org/10.1007/s10143-021-01541-1

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Abstract

Aneurysmal subarachnoid hemorrhage (SAH) is associated with a high mortality rate and may leave surviving patients severely disabled. After the initial hemorrhage, clinical outcome is further compromised by the occurrence of delayed cerebral ischemia (DCI). Overweight and obesity have previously been associated with protective effects in the post-bleeding phase. The aim of this study was to assess the effects of a patient’s body mass index (BMI) and leptin levels on the occurrence of DCI, DCI-related cerebral infarction, and clinical outcome. In total, 263 SAH patients were included of which leptin levels were assessed in 24 cases. BMI was recorded along disease severity documented by the Hunt and Hess and modified Fisher scales. The occurrence of clinical or functional DCI (neuromonitoring, CT Perfusion) was assessed. Long-term clinical outcome was documented after 12 months (extended Glasgow outcome scale). A total of 136 (51.7%) patients developed DCI of which 72 (27.4%) developed DCI-related cerebral infarctions. No association between BMI and DCI occurrence (P = .410) or better clinical outcome (P = .643) was identified. Early leptin concentration in serum (P = .258) and CSF (P = .159) showed no predictive value in identifying patients at risk of unfavorable outcomes. However, a significant increase of leptin levels in CSF occurred from 326.0 pg/ml IQR 171.9 prior to DCI development to 579.2 pg/ml IQR 211.9 during ongoing DCI (P = .049). In our data, no association between obesity and clinical outcome was detected. After DCI development, leptin levels in CSF increased either by an upsurge of active transport or disruption of the blood-CSF barrier. This trial has been registered at ClinicalTrials.gov (NCT02142166) as part of a larger-scale prospective data collection. BioSAB: https://clinicaltrials.gov/ct2/show/NCT02142166

Highlights

Aneurysmal subarachnoid hemorrhage (SAH) remains a devastating disease affecting around 9/100,000 people each year [8]
A single trial in SAH patients described a lower risk of delayed cerebral ischemia (DCI) and DCI-related infarction associated with elevated body mass index (BMI) [33]
In a receiver operating characteristics (ROC) analysis, early leptin concentration in serum (AUC = 0.662; 95% CI: 0.378 to 0.947, P = .258) and cerebrospinal fluid (CSF) (AUC = 0.712; 95% CI: 0.454 to 0.971; P = .159) showed no predictive value in identifying patients at risk of unfavorable outcome

Summary

Introduction

Aneurysmal subarachnoid hemorrhage (SAH) remains a devastating disease affecting around 9/100,000 people each year [8]. During the first 2 weeks post-hemorrhage, patients remain susceptible to ischemic strokes in which cerebral vasospasm plays an undisputed role alongside many other contributing factors [38] This delayed cerebral ischemia (DCI) can eventually result in cerebral infarctions, further compromising long-term clinical outcome [39]. Obesity is an established risk factor for cardio- and cerebrovascular disease, surgical complications, and nosocomial infections [2] Contrary to this association, there is an “obesity paradox” where an increased body mass index (BMI) was associated with an overall lower mortality and complication rate, after ischemic stroke [22, 34] and intracerebral hemorrhage [5, 21]. Previous studies have exclusively relied on BMI as an obesity variable, even though its sensitivity for high body fat mass has been shown to be only 50% [26]

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