Cisternal Blood Clearance Attenuates Systemic Inflammatory Response After Subarachnoid Hemorrhage

Aneurysmal subarachnoid hemorrhage (SAH) frequently triggers systemic inflammatory response syndrome (SIRS). SIRS has been associated with inferior outcomes and, specifically, delayed cerebral infarction after aneurysmal SAH. Here, we assess the impact of intracranial blood clearance through stereotactic catheter ventriculocisternostomy on SIRS in patients with aneurysmal SAH.

We assessed daily SIRS criteria (heart rate > 90 beats/min, respiratory rate > 20 breaths/min or abnormal respiratory coefficient, temperature > 38 °C or < 36 °C, white blood cell count < 4000 or > 12,000 cells/mm³) between admission and day 21 in 80 consecutive patients who underwent cisternal lavage through stereotactic catheter ventriculocisternostomy from 2015 to 2022. These patients were compared with 80 matched controls who received treatment at our institution between 2010 and 2015. We conducted a mixed effects model analysis using restricted maximum likelihood estimation to assess the effects of treatment groups on the SIRS rate while accounting for repeated measures. Additionally, Bonferroni's correction was employed to examine specific differences between groups at different time points.

The mean percentages of patients meeting SIRS criteria during the first 21 days after aneurysmal SAH were 23% in the matched cohort group and 14% in patients who underwent cisternal lavage (p < 0.001). Additionally, significant differences were observed in the mean leukocyte count (p = 0.047), mean heart rate (p = 0.019), and mean respiratory rate (p = 0.0018) between the two groups. However, there was no significant difference in mean body temperature (p = 0.36).

Intracranial blood clearance and cisternal lavage after aneurysmal SAH is associated with a decline in SIRS prevalence and severity.