The prognostic value of serial leukocyte adhesion molecules in post-aneurysmal subarachnoid hemorrhage

Background: Leukocyte recruitment and inflammatory response play an important role in the pathophysiology after aneurysmal subarachnoid hemorrhage (SAH). We determined whether leukocyte adhesion molecules after aneurysmal SAH can predict the presence of delayed cerebral infarction (DCI). Methods: Serial changes in P-selectin glycoprotein ligand-1 (PSGL-1), macrophage antigen-1 (Mac-1), and lymphocyte function-associated antigen-1 (LFA-1) expression by leukocyte subsets were prospectively examined using flow cytometry at various time points in 20 acute aneurysmal SAH patients and 21 healthy volunteers who were free of medications were enrolled as a control group. Results: Neutrophil (cut-off value of > 44.90) and monocyte (cut-off value of > 32.95) PSGL-1 expressions on admission were significantly higher in patients with DCI than in non-DCI patients, but the difference between neutrophil PGSL-1 and monocyte PGSL-1 levels between the two groups was no longer significant from Day 4 to Day 14 after aneurysmal SAH. After stepwise logistic regression analysis, only neutrophil PSGL-1 expression upon admission was independently associated with DCI. The mean hospitalization days were 44.4 ± 26.2 for those patients with DCI and 40.5 ± 26.4 for non-DCI patients. After a minimum 6-month follow-up period, the median BI score was 20 for DCI patients and 80 for non-DCI patients. Conclusions: Higher expressions of neutrophil PSGL-1 on admission may imply a danger of DCI in patients with aneurysmal SAH.