Objective: To investigate inflammatory processes after aneurysmal subarachnoid hemorrhage (aSAH) with network models.Methods: This is a retrospective observational study of serum samples from 45 participants with aSAH analyzed at multiple predetermined time points: ,24 hours, 24 to 48 hours, 3 to 5 days, and 6 to 8 days after aSAH. Concentrations of cytokines were measured with a 41-plex human immunoassay kit, and the Pearson correlation coefficients between all possible cytokine pairs were computed. Systematic network models were constructed on the basis of correlations between cytokine pairs for all participants and across injury severity. Trends of individual cytokines and correlations between them were examined simultaneously.Results: Network models revealed that systematic inflammatory activity peaks at 24 to 48 hours after the bleed. Individual cytokine levels changed significantly over time, exhibiting increasing, decreasing, and peaking trends. Platelet-derived growth factor (PDGF)-AA, PDGF-AB/BB, soluble CD40 ligand, and tumor necrosis factor-a (TNF-a) increased over time. Colony-stimulating factor (CSF) 3, interleukin (IL)-13, and FMS-like tyrosine kinase 3 ligand decreased over time. IL-6, IL-5, and IL-15 peaked and decreased. Some cytokines with insignificant trends show high correlations with other cytokines and vice versa. Many correlated cytokine clusters, including a plateletderived factor cluster and an endothelial growth factor cluster, were observed at all times. Participants with higher clinical severity at admission had elevated levels of several proinflammatory and anti-inflammatory cytokines, including IL-6, CCL2, CCL11, CSF3, IL-8, IL-10, CX3CL1, and TNF-a, compared to those with lower clinical severity.
Conclusions:Combining reductionist and systematic techniques may lead to a better understanding of the underlying complexities of the inflammatory reaction after aSAH. Neurology ® 2017;88:1535-1545 GLOSSARY aSAH 5 aneurysmal subarachnoid hemorrhage; CSF 5 colony-stimulating factor; DCI 5 delayed cerebral ischemia; EGF 5 epidermal growth factor; FGF-2 5 fibroblast growth factor-2; FLT3L 5 FMS-like tyrosine kinase 3 ligand; HH 5 Hunt-Hess; IFN-a2 5 interferon-a2; IFNG 5 type-II interferon family; IL 5 interleukin; MIP 5 macrophage inflammatory protein; Pcc 5 Pearson correlation coefficient; PDGF 5 platelet-derived growth factor; sCD40L 5 soluble CD40 ligand; SI 5 similarity index; TNF 5 tumor necrosis factor; VEGF 5 vascular endothelial growth factor.Aneurysmal subarachnoid hemorrhage (aSAH) affects z30,000 people annually and accounts for 10% to 15% of all strokes.1 Despite improvements in clinical management, morbidity after aSAH remains high. Studies have shown that early elevation of central and peripheral inflammatory cytokines is associated with delayed neurologic deteriorations.2 However, such studies typically use methods to examine differences in concentrations of individual cytokines across disease severity or clinical outcomes. They fail to account for the complexities an...