leptin and Subarachnoid-Hemorrhage

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.

Topics: Body Mass Index; Brain Ischemia; Cerebral Infarction; Humans; Leptin; Subarachnoid Hemorrhage

Patients with aneurysmal subarachnoid hemorrhage (SAH) typically develop appetite loss. However, the mechanisms regulating appetite are not understood. Ghrelin and leptin, both of which signal nutritional status and energy storage levels to the hypothalamus, are essential elements of the appetite system. Thus, the goal of this study was to investigate the relationship between appetite and ghrelin and leptin concentrations in patients with SAH.. Blood plasma or serum profiles and appetite status were measured in 19 patients with SAH who underwent aneurysmal clipping within 48 hours of SAH onset. Appetite status was measured using dietary oral calorie intake. All outcome variables were measured at an early (day 3) and late (day 8) time point after SAH onset (day 0).. Of the 19 patients studied, 6 (31.6%) showed lower dietary oral calorie intake at the late time point than at the early time point. In these patients with appetite loss, plasma hemoglobin (P < 0.02), albumin (P < 0.01), glucose (P < 0.01), plasma insulin (P < 0.04), and serum ghrelin (P < 0.03) concentrations were lower at the late time point than at the early time point. Serum leptin was higher at the late time point than at the early time point (P < 0.02).. In SAH patients, appetite loss may be induced by lower serum ghrelin and higher serum leptin concentrations resulting from high plasma glucose and insulin levels due to a catecholamine surge following SAH.

Topics: Aged; Appetite; Blood Glucose; Energy Intake; Female; Ghrelin; Humans; Insulin; Leptin; Male; Middle Aged; Nutritional Status; Postoperative Care; Subarachnoid Hemorrhage

To investigate the characteristic changes in serum estradiol and leptin levels in patients with cerebral-cardiac syndrome (CCS) induced by subarachnoid hemorrhage (SAH).. Ninety-six female patients with early stage of SAH (within 48 h of onset), who were admitted in our department between February 2008 and February 2014, were included in this study. Clinical conditions of patients were rated using Hunt-Hess scale. Serum levels of estradiol, leptin and echocardiography were determined in patients with various neurological injuries as well as in post-SAH patients and patients with SAH-induced CCS.. No significant differences (p > 0.05) were observed in the levels of estradiol or leptin between patients with different Hunt-Hess grades. While serum levels of estradiol and leptin were significantly elevated in SAH and CCS patients compared to normal controls (p < 0.05) but the elevated levels were more profound in CCS patients. Meanwhile there were also variable extents of left ventricular expansion and decrease of ejection fraction in CCS patients, with the same trends of estradiol and leptin.. Thus the results show that a significant increase in estradiol and leptin levels occurred in post-SAH CCS patients.

Topics: Adult; Aged; Cerebrovascular Disorders; Estradiol; Female; Heart Diseases; Humans; Leptin; Middle Aged; Subarachnoid Hemorrhage; Syndrome; Ultrasonography

Leptin has been identified as a plasma marker for outcomes in traumatic brain injury and intracerebral hemorrhage. We further investigated whether leptin might serve as a marker for severity and prognosis in aneurysmal subarachnoid hemorrhage. One hundred and eight consecutive patients and 108 sex and age - matched healthy subjects were recruited. Plasma leptin levels were measured by enzyme-linked immunosorbent assay. Clinical severity was assessed using World Federation of Neurological Surgeons score and Fisher score. Mortality and poor long-term outcome (Glasgow outcome scale scores of 1-3) at 6 months were recorded. Plasma leptin levels on admission were substantially higher in patients than in healthy controls, and were significantly associated with the clinical severity. There was also a significant association between leptin levels and clinical outcomes at 6 months in multivariate logistic regression analysis. Using receiver operating characteristic curves, we calculated areas under the curve for clinical outcomes at 6 months. The predictive performance of leptin was similar to, but did not obviously improve those of World Federation of Neurological Surgeons score and Fisher score. Thus, leptin may indicate clinical severity of the initial bleeding and also have prognostic value for clinical outcomes in aneurysmal subarachnoid hemorrhage and may therefore help in guiding treatment decisions in the setting of aneurysmal subarachnoid hemorrhage.

Topics: Adult; Biomarkers; Brain Injuries; Female; Glasgow Outcome Scale; Humans; Leptin; Male; Middle Aged; Prognosis; Severity of Illness Index; Subarachnoid Hemorrhage; Treatment Outcome