Abstract 96: What Critical Volume of Intraventricular Hemorrhage is Important in Intracerebral Haemorrhage? Interact2 Results

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Craig Anderson ◽  
Edward Chan ◽  
Xia Wang ◽  
Hisatomi Arima ◽  
Emma Heeley ◽  
...  
Keyword(s):  
Intracerebral Haemorrhage ◽  
Linear Relation ◽  
Controlled Trial ◽  
Intraventricular Haemorrhage ◽  
Clinical Severity ◽  
Logistic Regression Models ◽  
Poor Outcome ◽  
Threshold Volume ◽  
Clinically Significant ◽  
Poor Outcomes

Background and purpose: Intraventricular haemorrhage (IVH) predicts outcome in acute intracerebral haemorrhage (ICH), but there is uncertainty over the strength of association and what clinically relevant threshold volume is relevant to prognosis. We aimed to elucidate risk associations of IVH and outcome in participants of the INTERACT2 study. Methods: INTERACT2 was an international, multicenter, prospective, open, blinded endpoint, randomized controlled trial of 2839 patients with ICH (<6 hr) and elevated systolic BP (SBP) who were randomly assigned to intensive (target SBP <140mmHg) or guideline-based (SBP <180mmHg) BP management in 2008-2012. Associations of 740 (26%) patients with IVH on poor outcome (mRS >3) at 90 days, were determined in logistic regression models. Results: Patients with ICH-IVH were significantly older, had greater clinical severity, and more with prior ischemic stroke and deep and large hematoma volume, after adjustment for other variables. Poor outcome occurred in 67% of ICH-IVH patients compared with 49% of ICH-alone patients (odds ratio [OR] 0.5, 95% confidence interval [CI] 0.42-0.60; p<0.01). There was a strong linear relation between ICH volume and poor outcome. Compared to lowest quartile (Q1) IVH volume (0-2.07mL), OR for poor outcomes increased in Q2 (2.08-5.84 mL) 0.74 (95%CI 0.46-1.18 mL), Q3 (5.97-13-74 ml) 1.27 (95%CI 0.78-2.06), and Q4 (13.82-117.55) 1.56 (95%CI 0.94-2.58), p trend 0.03. Associations were stronger for death, where a baseline IVH volume of 5-10mL emerging as a statistically (and clinically) significant threshold for risk. Conclusion: While a linear relation exists between IVH and outcome in ICH, a 5-10mL volume appears an appropriate cut-point for clinical-decisions over use of interventions with risk.

Gender Differences in Characteristics and Outcome in Primary Intraventricular Hemorrhage

2019 ◽  
Vol 16 (4) ◽  
pp. 321-327
Author(s):  
Rui Guo ◽  
Lu Yin ◽  
Ruiqi Chen ◽  
Liang Zhou ◽  
Chao You ◽  
...  
Keyword(s):  
Gender Differences ◽  
Intraventricular Hemorrhage ◽  
Chronic Alcoholism ◽  
Monocyte Count ◽  
Rare Type ◽  
Acute Hydrocephalus ◽  
Logistic Regression Models ◽  
Poor Outcome ◽  
Poor Outcomes ◽  
Gcs Score

Background: Primary intraventricular hemorrhage (PIVH) is a rare type of Intracerebral Hemorrhage (ICH), which is poorly understood. This study aimed to investigate gender differences in patients' characteristics, management and outcome at discharge and 90 days after PIVH. Methods: Consecutive patients with PIVH from a single center in China were enrolled over a 7- year period. Gender differences in demographics, risk factors, etiological subtypes, treatment, and outcomes were examined. The logistic regression models were used in the study to identify the predictors of poor outcome. Results: In total, 174 patients were analyzed, and 77 (44.3%) of them were women. Women with PIVH were younger (p = 0.047), with lower systolic and diastolic blood pressure (p = 0.02 and p = 0.004, respectively). They had more cases caused by Moyamoya disease (p = 0.038). There were fewer patients with hypertension (p = 0.008), smoking (p＜0.001), chronic alcoholism (p＜0.001), harbored lower hemoglobin (p＜0.001) and Absolute Monocyte Count (AMC) (p = 0.04) at admission compared with men. There were no differences between female and male patients regarding the mortality and poor outcome in the multivariable-adjusted models ((OR = 0.57; 95% CI, 0.15-2.14) and (OR = 0.86; 95% CI, 0.32-2.37), respectively). In subgroup analysis after adjustment, the gender specific independent predictors for unfavorable outcome were higher with a Graeb score (OR = 1.78; 95% CI, 1.01-3.13) or AMC (OR = 9.66; 95% CI, 1.20-12.87) in women, and lower Glasgow coma scale (GCS) score (OR = 0.64; 95% CI, 0.47-0.87) or acute hydrocephalus (OR = 0.17; 95% CI, 0.03-0.86) in men. Conclusions: Women with PIVH exhibit some distinctive baseline features compared with men. The gender difference of the PIVH does not appear to affect the neurological outcome. The predictors of poor outcomes are Graeb score and AMC in women and GCS score and acute hydrocephalus in men.

Abstract P384: Outcomes of Endovascular Therapy in Patients With Pre-Stroke Mobility Impairment

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Rachel Beekman ◽  
Jie-Lena Sun ◽  
Brooke Alhanti ◽  
Lee H Schwamm ◽  
Eric Smith ◽  
...  
Keyword(s):  
Inpatient Rehabilitation ◽  
Stroke Severity ◽  
Limited Data ◽  
Mobility Impairment ◽  
Endovascular Thrombectomy ◽  
Stroke Registry ◽  
Logistic Regression Models ◽  
Poor Outcome ◽  
Poor Outcomes ◽  
Get With The Guidelines

Background and Purpose: Patients with pre-stroke mobility impairment were excluded from endovascular clinical trials. There is limited data regarding safety and outcomes of endovascular thrombectomy (EVT) in this population. We used a large, national dataset (Get With The Guidelines (GWTG)-Stroke) to evaluate the safety and outcomes of EVT in patients with pre-stroke mobility impairment (PSMI). Methods: We included patients who underwent EVT in the GWTG-Stroke registry between 2015 and 2019. PSMI was defined as inability to ambulate independently and poor outcome was defined as in-hospital mortality or discharge to hospice. GEE logistic regression models were used to evaluate the association between PSMI and outcomes. Results: Of 56,762 patients treated with EVT, 2919 (5.14%) had PSMI. Patients with PSMI were older (median 79 [IQR 70-87] vs 70 [59-80], P<0.001), more likely to be female (63.4% vs 49.2%, P<0.001), had more medical comorbidities, presented with a higher NIHSS (19 [12-24] vs 15 [9-21], P<0.001), and were less likely to be treated with tPA (36.8% vs 45.6%, P<0.001). PSMI was not associated with intracranial hemorrhage but was associated with poor outcome (Table 1). Patients with PSMI with poor outcomes were more likely to be older (83 [74-89] vs 77 [68-86], P<0.001) and have a higher presenting NIHSS (21 [16-25] vs 16 [11-22], p<0.001). Forty-nine percent of patients with PSMI with age >80 years and NIHSS >20 had a poor outcome. Conclusions: Amongst patients with PSMI treated with EVT, two thirds survived and one third were discharged to home or to inpatient rehabilitation. Advanced age and increased stroke severity increased the likelihood of poor outcomes. EVT appears safe in patients with PSMI, yet further study of effectiveness in this population is warranted.

scholarly journals Clinical Characteristics and Predictors of Poor Hospital Discharge Outcome for Young Children with Abusive Head Trauma

2019 ◽  
Vol 8 (3) ◽  
pp. 390 ◽  
Author(s):  
Chih-Chi Chen ◽  
Po-Chuan Hsieh ◽  
Carl Chen ◽  
Yu-Wei Hsieh ◽  
Chia-Ying Chung ◽  
...  
Keyword(s):  
Head Trauma ◽  
Head Injuries ◽  
Abusive Head Trauma ◽  
Older Age ◽  
Subdural Hemorrhage ◽  
Logistic Regression Models ◽  
Poor Outcome ◽  
Radiologic Findings ◽  
Early Predictors ◽  
Poor Outcomes

Children with abusive head trauma tend to have worse outcomes than children with accidental head trauma. However, current predictors of poor outcomes for children with abusive head trauma are still limited. We aim to use clinical data to identify early predictors of poor outcome at discharge in children with abusive head trauma. In the 10-year observational retrospective cohort study, children aged between zero and four years with abusive or accidental head trauma were recruited. Multivariate logistic regression models were applied to evaluate factors associated with poor prognosis in children with abusive head trauma. The primary outcome was mortality or a Glasgow Coma Scale (GCS) motor component score of less than 6 at discharge. A total of 292 head trauma children were included. Among them, 59 children had abusive head trauma. In comparison to children with accidental head trauma, children with abusive head trauma were younger, had more severe head injuries, and experienced a higher frequency of post-traumatic seizures. Their radiologic findings showed common presence of subdural hemorrhage, cerebral edema, and less epidural hemorrhage. They were more in need of neurosurgical intervention. In the multivariate analysis for predictors of poor outcome in children with abusive head trauma, initial GCS ≤ 5 (versus GCS > 5 with the adjusted odds ratio (OR) = 25.7, 95% confidence interval (CI) = 1.5–432.8, p = 0.024) and older age (per year with the adjusted OR = 3.3, 95% CI = 1.2–9.5, p = 0.024) were independently associated with poor outcome. These findings demonstrate the characteristic clinical differences between children with abusive and accidental head trauma. Initial GCS ≤ 5 and older age are predictive of poor outcome at discharge in children with abusive head trauma.

scholarly journals Prolonged Duration of Blood Pressure Drops During General Anesthesia Is Associated With Worse Outcomes After Mechanical Thrombectomy

2021 ◽  
Vol 12 ◽  
Author(s):  
Chao Xu ◽  
Gaoping Lin ◽  
Zheyu Zhang ◽  
Tianyu Jin ◽  
Ning Li ◽  
...  
Keyword(s):  
Blood Pressure ◽  
General Anesthesia ◽  
Mechanical Thrombectomy ◽  
Binary Logistic Regression ◽  
Vessel Occlusion ◽  
Pressure Drops ◽  
Logistic Regression Models ◽  
Poor Outcome ◽  
Prolonged Duration ◽  
Poor Outcomes

Background and Purpose: Optimal periprocedural management of blood pressure during mechanical thrombectomy (MT) remains controversial. This study aimed to investigate the relationship between the duration of blood pressure drops during general anesthesia and the outcomes in large vessel occlusion (LVO) patients treated with MT.Methods: We retrospectively reviewed our prospectively collected data for LVO patients treated with MT between January 2018 and July 2020. Intraprocedural mean arterial pressure (MAP) was recorded every 5 min throughout the procedure. Baseline MAP minus each MAP value recorded during general anesthesia was defined ΔMAP. Cumulated time (in min) and longest continuous episode (in min) with ΔMAP more than 10, 15, 20, 25, and 30 mmHg were calculated, respectively. Poor outcome was defined as 90-day modified Rankin score (mRS) 3–6. Associations between cumulated time of different ΔMAP thresholds and poor outcome were determined using binary logistic regression models.Results: A total of 131 patients were finally included in the study. After controlling for age, atrial fibrillation, baseline NIHSS, baseline ASPECTS, procedure duration of MT, and times of retrieval attempts, the results indicated that cumulated time of MAP drop more than 10 mmHg (OR 1.013; 95% CI 1.004–1.023; P = 0.007) and 15 mmHg (OR 1.011; 95% CI 1.002–1.020; P = 0.017) were independently associated with poor outcomes.Conclusion: Prolonged episodes of intraprocedural MAP lowering were more likely to have poor outcomes in LVO patients following MT with general anesthesia, which might be helpful in guiding intraprocedural hemodynamic management of patients under general anesthesia.

Alanine Aminotransferase Predicts Outcomes in Elderly Patients with Aneurysmal Subarachnoid Hemorrhage

2019 ◽  
Vol 16 (1) ◽  
pp. 89-95
Author(s):  
Jianfeng Zheng ◽  
Rui Xu ◽  
Zongduo Guo ◽  
Xiaochuan Sun
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Elderly Patients ◽  
Clinical Outcomes ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Laboratory Data ◽  
Cardiac Complications ◽  
World Population ◽  
Systemic Complications ◽  
Poor Outcome ◽  
Poor Outcomes

Objective: With the aging of the world population, the number of elderly patients suffering from aneurysmal subarachnoid hemorrhage (aSAH) is gradually growing. We aim to investigate the potential association between plasma ALT level and clinical complications of elderly aSAH patients, and explore its predictive value for clinical outcomes of elderly aSAH patients. Methods: Between January 2013 and March 2018, 152 elderly aSAH patients were analyzed in this study. Clinical information, imaging findings and laboratory data were reviewed. According to the Glasgow Outcome Scale (GOS), clinical outcomes at 3 months were classified into favorable outcomes (GOS 4-5) and poor outcomes (GOS 1-3). Logistic regression analysis was used to assess the indicators associated with poor outcomes, and receiver curves (ROC) and corresponding area under the curve (AUC) were used to detect the accuracy of the indicator. Results: A total of 48 (31.6 %) elderly patients with aSAH had poor outcome at 3 months. In addition to ICH, IVH, Hunt-Hess 4 or 5 Grade and Modified Fisher 3 or 4 Grade, plasma ALT level was also strongly associated with poor outcome of elderly aSAH patients. After adjusting for other covariates, plasma ALT level remained independently associated with pulmonary infection (OR 1.05; 95% CI 1.00–1.09; P = 0.018), cardiac complications (OR 1.05; 95% CI 1.01–1.08; P = 0.014) and urinary infection (OR 1.04; 95% CI 1.00–1.08; P = 0.032). Besides, plasma ALT level had a predictive ability in the occurrence of systemic complications (AUC 0.676; 95% CI: 0.586– 0.766; P<0.001) and poor outcome (AUC 0.689; 95% CI: 0.605–0.773; P<0.001) in elderly aSAH patients. Conclusion: Plasma ALT level of elderly patients with aSAH was significantly associated with systemic complications, and had additional clinical value in predicting outcomes. Given that plasma ALT levels on admission could help to identify high-risk elderly patients with aSAH, these findings are of clinical relevance.

scholarly journals Estimating the minimum important difference in the DEMQOL instrument in people with dementia

2021 ◽  
Author(s):  
Ellen C. Lee ◽  
Jessica Wright ◽  
Stephen J. Walters ◽  
Cindy L. Cooper ◽  
Gail A. Mountain
Keyword(s):  
Quality Of Life ◽  
Controlled Trial ◽  
Minimum Important Difference ◽  
Absolute Change ◽  
People With Dementia ◽  
Related Quality ◽  
Registration Number ◽  
Clinically Significant ◽  
Randomised Controlled

Abstract Purpose The Dementia-Related Quality of Life (DEMQOL) measure and the DEMQOL-Utility Score (DEMQOL-U) are validated tools for measuring quality of life (QOL) in people with dementia. What score changes translate to a clinically significant impact on patients’ lives was unknown. This study establishes the minimal important differences (MID) for these two instruments. Methods Anchor-based and distribution-based methods were used to estimate the MID scores from patients enrolled in a randomised controlled trial. For the anchor-based method, the global QOL (Q29) item from the DEMQOL was chosen as the anchor for DEMQOL and both Q29 and EQ-5D for DEMQOL-U. A one category difference in Q29, and a 0.07 point difference in EQ-5D score, were used to classify improvement and deterioration, and the MID scores were calculated for each category. These results were compared with scores obtained by the distribution-based methods. Results A total of 490 people with dementia had baseline DEMQOL data, of these 386 had 8-month data, and 344 had 12-month DEMQOL data. The absolute change in DEMQOL for a combined 1-point increase or decrease in the Q29 anchor was 5.2 at 8 months and 6.0 at 12 months. For the DEMQOL-U, the average absolute change at 8 and 12 months was 0.032 and 0.046 for the Q29 anchor and 0.020 and 0.024 for EQ-5D anchor. Conclusion We present MID scores for the DEMQOL and DEMQOL-U instruments obtained from a large cohort of patients with dementia. An anchored-based estimate of the MID for the DEMQOL is around 5 to 6 points; and 0.02 to 0.05 points for the DEMQOL-U. The results of this study can guide clinicians and researchers in the interpretation of these instruments comparisons between groups or within groups of people with dementia. Trial Registration Number and date of registration: ISRCTN17993825 on 11th October 2016.

scholarly journals Trajectories of fatigue in actively treated patients with established rheumatoid arthritis starting biologic DMARD therapy

RMD Open ◽  
2020 ◽  
Vol 6 (3) ◽  
pp. e001372
Author(s):  
Sella Aarrestad Provan ◽  
Brigitte Michelsen ◽  
Joseph Sexton ◽  
Tillmann Uhlig ◽  
Hilde Berner Hammer
Keyword(s):  
Rheumatoid Arthritis ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Tender Joint Count ◽  
Tender Joint ◽  
Logistic Regression Models ◽  
Patient Reported ◽  
Biologic Dmard ◽  
Clinically Significant

ObjectivesTo define fatigue trajectories in patients with rheumatoid arthritis (RA) who initiate biological DMARD (bDMARD) treatment, and explore baseline predictors for a trajectory of continued fatigue.MethodsOne-hundred and eighty-four patients with RA initiating bDMARDs were assessed at 0, 1, 2, 3, 6 and 12 months. Swollen and tender joint counts, patient reported outcomes (PROMs), blood samples and ultrasound examinations were collected at each time point. Fatigue was assessed by the fatigue Numeric Rating Scale (0–10) from the Rheumatoid Arthritis Impact of Disease (RAID) questionnaire. Clinically significant fatigue was predefined as fatigue ≥4. Three trajectories of interest were defined according to level of RAID fatigue: no fatigue (≤3 at 5/6 visits), improved fatigue (≥4 at start, but ≤3 at follow-up) and continued fatigue (≥4 at 5/6 visits). Baseline variables were compared between groups by bivariate analyses, and logistic regression models were used to explore baseline predictors of continued vs improved fatigue.ResultsThe majority of patients starting bDMARD therapy followed one of three fatigue trajectories, (no fatigue; n=61, improved; n=33 and continued fatigue; n=53). Patients with continued fatigue were more likely to be anti–citrullinated protein antibody and/or rheumatoid factor positive and had higher baseline PROMs compared to the other groups, while there were no differences between the groups for variables of inflammation including. Patient global, tender joint count and anxiety were predictors for the continued fatigue trajectory.DiscussionA trajectory of continued fatigue was determined by PROMs and not by inflammatory RA disease activity.

scholarly journals Tranexamic acid for acute intracerebral haemorrhage growth based on imaging assessment (TRAIGE): a multicentre, randomised, placebo-controlled trial

2021 ◽  
pp. svn-2021-000942
Author(s):  
Jingyi Liu ◽  
Ximing Nie ◽  
Hongqiu Gu ◽  
Qi Zhou ◽  
Haixin Sun ◽  
...  
Keyword(s):  
Placebo Group ◽  
Tranexamic Acid ◽  
Intracerebral Haemorrhage ◽  
Intracranial Haemorrhage ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Intracerebral Haematoma ◽  
Spot Sign ◽  
Double Blind ◽  
Risk Of Death

BackgroundStudies show tranexamic acid can reduce the risk of death and early neurological deterioration after intracranial haemorrhage. We aimed to assess whether tranexamic acid reduces haematoma expansion and improves outcome in intracerebral haemorrhage patients susceptible to haemorrhage expansion.MethodsWe did a prospective, double-blind, randomised, placebo-controlled trial at 10 stroke centres in China. Acute supratentorial intracerebral haemorrhage patients were eligible if they had indication of haemorrhage expansion on admission imaging (eg, spot sign, black hole sign or blend sign), and were treatable within 8 hours of symptom onset. Patients were randomly assigned (1:1) to receive either tranexamic acid or a matching placebo. The primary outcome was intracerebral haematoma growth (>33% relative or >6 mL absolute) at 24 hours. Clinical outcomes were assessed at 90 days.ResultsOf the 171 included patients, 124 (72.5%) were male, and the mean age was 55.9±11.6 years. 89 patients received tranexamic acid and 82 received placebo. The primary outcome did not differ significantly between the groups: 36 (40.4%) patients in the tranexamic acid group and 34 (41.5%) patients in the placebo group had intracranial haemorrhage growth (OR 0.96, 95% CI 0.52 to 1.77, p=0.89). The proportion of death was lower in the tranexamic acid treatment group than placebo group (8.1% vs 10.0%), but there were no significant differences in secondary outcomes including absolute intracranial haemorrhage growth, death and dependency.ConclusionsAmong patients susceptible to haemorrhage expansion treated within 8 hours of stroke onset, tranexamic acid did not significantly prevent intracerebral haemorrhage growth. Larger studies are needed to assess safety and efficacy of tranexamic acid in intracerebral haemorrhage patients.

scholarly journals The Diagnostic Yield of Magnetic Resonance Cholangiopancreatography in the Setting of Acute Pancreaticobiliary Disease — A Single Center Experience

2021 ◽  
pp. 084653712110137
Author(s):  
Sultan Yahya ◽  
Abdullah Alabousi ◽  
Peri Abdullah ◽  
Milita Ramonas
Keyword(s):  
Magnetic Resonance ◽  
Diagnostic Yield ◽  
Binary Logistic Regression ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Significant Discrepancy ◽  
Logistic Regression Models ◽  
Single Center Experience ◽  
New Information ◽  
Clinically Significant ◽  
Enzyme Elevation

Purpose: To discern whether preceding ultrasound (US) results, patient demographics and biochemical markers can be implemented as predictors of an abnormal Magnetic Resonance Cholangiopancreatography (MRCP) study in the context of acute pancreaticobiliary disease. Methods: A retrospective study was performed assessing US results, age, gender, elevated lipase and biliary enzymes for consecutive patients who underwent an urgent MRCP following an initial US for acute pancreaticobiliary disease between January 2017-December 2018. Multivariable binary logistic regression models were constructed to assess for predictors of clinically significant MRCPs, and discrepant US/MRCP results. Results: A total of 155 patients (mean age 56, 111 females) were included. Age (OR 1.03, P < 0.05), hyperlipasemia (OR 5.33, P < 0.05) and a positive US (OR 40.75, P < 0.05) were found to be independent predictors for a subsequent abnormal MRCP. Contrarily, gender and elevated biliary enzymes were not reliable predictors of an abnormal MRCP, or significant MRCP/US discrepancies. Of 66 cases (43%) of discordant US/MRCPs, half had clinically significant discrepant findings such as newly discovered choledocholithiasis and pancreaticobiliary neoplasia. Age was the sole predictor for a significant US/MRCP discrepancy, with 2% increase in the odds of a significant discrepancy per year of increase in age. Conclusion: An abnormal US, hyperlipasemia and increased age serve as predictors for a subsequent abnormal MRCP, as opposed to gender and biliary enzyme elevation. Age was the sole predictor of a significant US/MRCP discrepancy that provided new information which significantly impacted subsequent management. In the remaining cases, however, MRCP proved useful in reaffirming the clinical diagnosis and avoiding further investigations.

Abstract TMP23: Inflammasome-derived Caspase-1 is Elevated in the Cerebrospinal Fluid of Subarachnoid Hemorrhage Patients and Correlated to Outcome

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Yonatan Hirsch ◽  
Joseph R Geraghty ◽  
Eitan A Katz ◽  
Jeffrey A Loeb ◽  
Fernando Testai
Keyword(s):  
Cerebrospinal Fluid ◽  
Subarachnoid Hemorrhage ◽  
External Ventricular Drain ◽  
Analysis Of Covariance ◽  
Control Group ◽  
Normal Brain ◽  
Poor Outcome ◽  
Caspase 1 ◽  
Initial Severity ◽  
Poor Outcomes

Introduction: The role of neuroinflammation following aneurysmal subarachnoid hemorrhage (SAH) and its relationship to outcome is the subject of many ongoing studies. The proteolytic enzyme, caspase-1, activated by the inflammasome complex, is known to contribute to numerous downstream pro-inflammatory effects. In this study, we investigated caspase-1 activity in the cerebrospinal fluid (CSF) of SAH patients and its association to outcome. Methods: SAH patients were recruited from a regional stroke referral center. CSF samples from 18 SAH subjects were collected via an external ventricular drain and obtained within 72 hours of the onset of symptoms. For control subjects, we collected the CSF from 9 patients undergoing lumbar puncture with normal CSF and normal brain MRI. Caspase-1 activity was measured using commercially available luminescence assays. SAH subjects were categorized at hospital discharge into those with good outcomes (Glasgow Outcome Scale, GOS, of 4-5) and poor outcomes (GOS of 1-3). The levels of caspase-1 activity in various groups were analyzed using Mann-Whitney and Pearson correlation tests. Caspase-1 activity was also adjusted by initial severity of bleed using analysis of covariance (ANCOVA). Results: Caspase-1 levels from SAH patients were significantly higher than that measured from the control group (mean 1.06x10-2 vs 1.90x10-3 counts per second (CPS)/μl*min), p = 0.0002). Within the SAH group, 10 patients (55.6%) had good outcomes and 8 patients (44.4%) had poor outcomes. Caspase-1 activity was significantly higher in the poor outcome group (mean 1.54x10-2 vs 1.60x10-3 CPS/μl*min), p = 0.0012). Additionally, caspase-1 activity had a statistically significant correlation with GOS score (r = -0.60; p = 0.0100). When adjusted for initial severity of bleed, the difference in caspase-1 activity in good vs. poor outcome remained significant (adjusted mean 7.10x10-3 vs. 2.54x10-2 CPS/μl*min, p=0.004). Conclusions: The inflammasome-dependent protein caspase-1 is elevated in CSF early after SAH and higher in those with poor functional outcome. Inflammasome activity therefore may serve as a novel biomarker to predict outcome shortly after aneurysm rupture.

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