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Open Access Research

Cerebrospinal fluid and plasma cytokines after subarachnoid haemorrhage: CSF interleukin-6 may be an early marker of infection

Stephen J Hopkins1*, Catherine J McMahon3, Navneet Singh1, James Galea1, Margaret Hoadley1, Sylvia Scarth1, Hiren Patel1, Andy Vail1, Sharon Hulme1, Nancy J Rothwell2, Andrew T King1 and Pippa J Tyrrell1

Author Affiliations

1 The University of Manchester Stroke & Vascular Centre, Manchester Academic Health Science Centre, Salford Royal Hospitals Foundation Trust, Eccles Old Road, Stott Lane, Salford, M6 8HD, UK

2 Faculty of Life Sciences, University of Manchester, AV Hill Building, University of Manchester, Oxford Road, Manchester, M13 9PT, UK

3 Department of Neurosurgery, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK

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Journal of Neuroinflammation 2012, 9:255  doi:10.1186/1742-2094-9-255

Published: 23 November 2012

Abstract

Background

Cytokines and cytokine receptor concentrations increase in plasma and cerebrospinal fluid (CSF) of patients following subarachnoid haemorrhage (SAH). The relationship between plasma and CSF cytokines, and factors affecting this, are not clear.

Methods

To help define the relationship, paired plasma and cerebrospinal fluid (CSF) samples were collected from patients subject to ventriculostomy. Concentrations of key inflammatory cytokines, interleukin (IL)-1ß, IL-1 receptor antagonist (IL-1Ra), IL-1 receptor 2, IL-6, IL-8, IL-10, tumour necrosis factor (TNF)-α, and TNF receptors (TNF-R) 1 and 2 were determined by immunoassay of CSF and plasma from 21 patients, where samples were available at three or more time points.

Results

Plasma concentrations of IL-1ß, IL-1Ra, IL-10, TNF-α and TNF-R1 were similar to those in CSF. Plasma TNF-R2 and IL-1R2 concentrations were higher than in CSF. Concentrations of IL-8 and IL-6 in CSF were approximately10 to 1,000-fold higher than in plasma. There was a weak correlation between CSF and plasma IL-8 concentrations (r = 0.26), but no correlation for IL-6. Differences between the central and peripheral pattern of IL-6 were associated with episodes of ventriculostomy-related infection (VRI). A VRI was associated with CSF IL-6 >10,000 pg/mL (P = 0.0002), although peripheral infection was not significantly associated with plasma IL-6.

Conclusions

These data suggest that plasma cytokine concentrations cannot be used to identify relative changes in the CSF, but that measurement of CSF IL-6 could provide a useful marker of VRI.

Keywords:
Cerebrospinal fluid; Cytokines; Infection; Interleukin-6; Markers; Plasma; Subarachnoid haemorrhage; Ventriculostomy