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Associations between cerebrospinal fluid protein concentrations, serum albumin concentrations and intracranial pressure in neurotrauma and intracranial haemorrhage

Department of Intensive Care, Royal Perth Hospital, Perth, Western Australia, Australia

Summary

Recent evidence suggests that using intravenous isotonic albumin solution for haemodynamic resuscitation in neurotrauma is associated with adverse outcomes. This study assessed the correlations between cerebrospinal fluid protein concentrations, serum albumin concentrations and intracranial pressure in a cohort of neurosurgical patients. After obtaining ethics committee approval, correlations between concomitant cerebrospinal fluid protein concentrations, serum albumin concentrations and the mean daily intracranial pressure of 63 consecutive neurosurgical patients, grouped as neurotrauma or intracranial haemorrhage, admitted between 1 January 2007 and 31 December, were assessed. The mean daily intracranial pressure was significantly associated with cerebrospinal fluid protein concentrations (Spearman correlation coefficient [SCC]=0.496, P=0.001), white cell counts (SCC=0.359, P=0.001), red cell counts (SCC=0.399, P=0.001) and serum albumin concentrations (SCC=0.431,P=0.001) in patients with neurotrauma (n=23). Cerebrospinal fluid protein concentrations were also significantly associated with concomitant serum albumin concentrations (SCC=0.393, P=0.001) in these patients. In patients with intracranial haemorrhage (n=40), the mean daily intracranial pressure was only significantly associated with cerebrospinal fluid white cell and red cell counts but not cerebrospinal fluid protein and serum albumin concentrations. In summary, intracranial pressure is correlated with cerebrospinal fluid protein and serum albumin concentrations in patients with severe neurotrauma, and these suggest that blood-brain barrier may not be completely intact after severe neurotrauma.

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