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Local and systemic pro-inflammatory and anti-inflammatory cytokine patterns in patients with chronic subdural hematoma: a prospective study

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Abstract

Objective and design

Innate immune pro- and anti-inflammatory responses in patients with chronic subdural hematoma (CSDH) were investigated by measuring and comparing the systemic and subdural fluid levels of cytokines.

Materials and method

Cytokine values were analyzed in samples obtained during surgery of 56 adult patients who were operated on for unilateral CSDHs using a Multiplex antibody bead kit.

Results

There were significantly higher levels of the pro-inflammatory IL-2R (p = 0.004), IL-5 (p < 0.001), IL-6 (p < 0.001), and IL-7 (p < 0.001), and anti-inflammatory mediators IL-10 (p < 0.001) and IL-13 (p = 0.002) in CSDH fluid compared with systemic levels. The pro-inflammatory TNF-alpha (p < 0.001), IL-1beta (p < 0.001), IL-2 (p = 0.007) and IL-4 (p < 0.001) were significantly lower in hematoma fluid compared with systemic levels. The ratios between pro- versus anti-inflammatory cytokines were statistically significant higher in CSDH (7.8) compared with systemic levels (1.3).

Conclusions

The innate immune responses occur both locally at the site of CSDH, as well as systematically in patients with CSDH. The local hyper-inflammatory and low anti-inflammatory responses exist simultaneously. The findings suggest poorly coordinated innate immune responses at the site of CSDH that may lead to propagating of local inflammatory process and basically contribute to formation and progression of CSDH.

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Acknowledgments

This study was supported by a grant from the Department of Neurosurgery, Oslo University Hospital, Oslo, Norway. We highly acknowledge Mrs Aina Mari Lian for excellent technical assistance and Mrs Annet Tøen for skilled database management.

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Authors and Affiliations

  1. Department of Neurosurgery, Oslo University Hospital, P.O. Box 4950, Nydalen, 0424, Oslo, Norway

    Milo Stanisic, Karl-Fredrik Lindegaard, Jon Ramm-Pettersen, Jugoslav Ivanovic, Ane Konglund, Eivind Ilstad, Tiril Sandell, Omar Ellingsen & Terje Sæhle

  2. Institute of Surgical Research Rikshospitalet, Oslo University Hospital, P.O. Box 4950, Nydalen, 0424, Oslo, Norway

    Ansgar Oddne Aasen

  3. Biostatistics and Epidemiology Unit, Oslo University Hospital, P.O. Box 4950, Nydalen, 0424, Oslo, Norway

    Are Hugo Pripp

  4. Department of Biomaterials, Faculty of Dentistry, University of Oslo, P.O. Box 1109, Nydalen, 0317, Oslo, Norway

    Staale Petter Lyngstadaas

  5. Faculty of Medicine, University of Oslo, Oslo, Norway

    Ansgar Oddne Aasen & Karl-Fredrik Lindegaard

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  1. Milo Stanisic
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  2. Ansgar Oddne Aasen
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Correspondence to Milo Stanisic.

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Stanisic, M., Aasen, A.O., Pripp, A.H. et al. Local and systemic pro-inflammatory and anti-inflammatory cytokine patterns in patients with chronic subdural hematoma: a prospective study. Inflamm. Res. 61, 845–852 (2012). https://doi.org/10.1007/s00011-012-0476-0

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  • DOI: https://doi.org/10.1007/s00011-012-0476-0

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