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Kwan K, Arapi O, Wagner KE, et al. Cerebrospinal fluid macrophage migration inhibitory factor: a potential predictor of cerebral vasospasm and clinical outcome after aneurysmal subarachnoid hemorrhage. J Neurosurg. 2019;1-6doi: 10.3171/2019.6.JNS19613.
Kwan, K., Arapi, O., Wagner, K. E., Schneider, J., Sy, H. L., Ward, M. F., Sison, C. P., Li, C., Eisenberg, M. B., Chalif, D., Narayan, R. K., Miller, E. J., & Ledoux, D. (2019). Cerebrospinal fluid macrophage migration inhibitory factor: a potential predictor of cerebral vasospasm and clinical outcome after aneurysmal subarachnoid hemorrhage. Journal of neurosurgery, 1-6. https://doi.org/10.3171/2019.6.JNS19613
Kwan, Kevin, et al. "Cerebrospinal fluid macrophage migration inhibitory factor: a potential predictor of cerebral vasospasm and clinical outcome after aneurysmal subarachnoid hemorrhage." Journal of neurosurgery vol. (2019): 1-6. doi: https://doi.org/10.3171/2019.6.JNS19613
Kwan K, Arapi O, Wagner KE, Schneider J, Sy HL, Ward MF, Sison CP, Li C, Eisenberg MB, Chalif D, Narayan RK, Miller EJ, Ledoux D. Cerebrospinal fluid macrophage migration inhibitory factor: a potential predictor of cerebral vasospasm and clinical outcome after aneurysmal subarachnoid hemorrhage. J Neurosurg. 2019 Oct 04;1-6. doi: 10.3171/2019.6.JNS19613. Epub 2019 Oct 04. PMID: 31585427.
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J Neurosurg. 2019 Oct 04;1-6. doi: 10.3171/2019.6.JNS19613. Epub 2019 Oct 04.

Cerebrospinal fluid macrophage migration inhibitory factor: a potential predictor of cerebral vasospasm and clinical outcome after aneurysmal subarachnoid hemorrhage.

Journal of neurosurgery

Kevin Kwan, Orseola Arapi, Katherine E Wagner, Julia Schneider, Heustein L Sy, Mary Frances Ward, Cristina P Sison, Chunyan Li, Mark B Eisenberg, David Chalif, Raj K Narayan, Edmund J Miller, David Ledoux

Affiliations

  1. 1Department of Neurosurgery, North Shore University Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset.
  2. 2Department of Neurosurgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York.
  3. 3Department of Neurology, Long Island Jewish Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Queens.
  4. 4Biostatistics Unit, The Feinstein Institute for Medical Research, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset.
  5. 5Department of Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset; and.
  6. 6Heart and Lung Research Unit, The Feinstein Institute for Medical Research, Manhasset, New York.

PMID: 31585427 DOI: 10.3171/2019.6.JNS19613

Abstract

OBJECTIVE: In patients with aneurysmal subarachnoid hemorrhage (aSAH), poor outcomes have been shown to be correlated with subsequent cerebral vasospasm (CV) and delayed cerebral ischemia (DCI). The identification of novel biomarkers may aid in the prediction of which patients are vulnerable to developing vasospasm, cerebral ischemia, and neurological deterioration.

METHODS: In this prospective clinical study at North Shore University Hospital, patients with aSAH or normal pressure hydrocephalus (NPH) with external ventricular drains were enrolled. The concentration of macrophage migration inhibitory factor (MIF) in CSF was assessed for correlation with CV or DCI, the primary outcome measures.

RESULTS: Twenty-five patients were enrolled in the aSAH group and 9 were enrolled in the NPH group. There was a significant increase in aggregate CSF MIF concentration in patients with aSAH versus those with NPH (24.4 ± 19.2 vs 2.3 ± 1.1 ng/ml, p < 0.0002). Incidence of the day of peak MIF concentration significantly correlated with the onset of clinical vasospasm (rho = 0.778, p < 0.0010). MIF concentrations were significantly elevated in patients with versus those without evidence of DCI (18.7 ± 4.93 vs 8.86 ± 1.28 ng/ml, respectively, p < 0.0025). There was a significant difference in MIF concentrations between patients with infection versus those without infection (16.43 ± 4.21 vs 8.5 ± 1.22 ng/ml, respectively, p < 0.0119).

CONCLUSIONS: Preliminary evidence from this study suggests that CSF concentrations of MIF are correlated with CV and DCI. These results, however, could be confounded in the presence of clinical infection. A study with a larger patient sample size is necessary to corroborate these findings.

Keywords: CV = cerebral vasospasm; DCI = delayed cerebral ischemia; EVD = external ventricular drain; HH = Hunt and Hess; MIF = macrophage migration inhibitory factor; NPH = normal pressure hydrocephalus; WFNS = World Federation of Neurosurgical Societies; aSAH = aneurysmal subarachnoid hemorrhage; biomarker; cerebral aneurysm; delayed cerebral ischemia; mRS = modified Rankin Scale; macrophage migration inhibitory factor; subarachnoid hemorrhage; vascular disorders

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