Proportional analysis of percentage drop in serum bilirubin versus Imax was measured using Fisher’s exact test. In all, 20 patients were recruited into the study over 18 months (14 men and 6 women were recruited). All patients were required to have an MdF score of >32 as defined by the study inclusion criteria. There was no correlation between baseline bilirubin, MdF, Lille score, or GAHS and mortality at 6 months (P = 0.45, P = 0.54; P = 0.70, and P = 0.97, respectively; Fig. 1) in this cohort of SAH. A drop in serum levels of bilirubin in the first 7 days of treatment

with steroids (clinical steroid sensitivity) has been shown to correlate with outcome in SAH.25 Consistent with this, we saw a strong correlation between this parameter and 6-month mortality in our patient cohort (Fig. 1), indicating CH5424802 mw that our cohort is similar to those previously studied in SAH. Subjects were categorized as steroid-resistant by in vitro criteria (Imax <60%). The overall prevalence of clinical steroid resistance in this patient cohort was high (68%)—higher than the values seen in other inflammatory conditions and the in vitro steroid resistance seen in the general population (about 30%).13, 15, 26,

27 No statistical differences in baseline MdF, Lille score, GAHS, or baseline (day 0) bilirubin were seen between the in vitro steroid-resistant and steroid-sensitive groups (Fig. 2). R428 nmr However, in vitro steroid resistance, as indicated by Imax <60%, was significantly associated with outcome in response to steroid therapy as determined by mortality at 6 months (P = 0.03) (Fig. 3). 82% (9/11) of in vitro steroid-resistant patients were dead at 6 months as compared to 21% (2/9) of steroid-sensitive patients (P = 0.03). In

patients who survived for 6 months following their treatment, only 2 of 11 (21%) had an Imax value of lower than 60%. Consistent with this finding, patients who had a serum bilirubin fall of < 25% in the first 7 days of steroid treatment also had a lower Imax (Fig. 4). 91% (10/11) of in vitro steroid-resistant click here patients failed to show a significant fall in bilirubin at day 7 as compared to 44% (4/9) of steroid-sensitive patients (P < 0.05). In those patients demonstrating in vitro steroid resistance as measured by an Imax value <60% (n = 11), competitive inhibition of IL-2 at the high-affinity CD25 receptor with 10 μg/mL basiliximab improved lymphocyte suppression in the presence of high-dose dexamethasone, P = 0.002 (Fig. 5). Basiliximab improved Imax in 91% (10/11) of in vitro steroid-resistant patients (P = 0.002). We have shown here that in a cohort of patients with SAH (MdF/Maddrey score >32 at baseline) treated with a standard steroid regime, clinical outcome (survival at 6 months) correlates with an in vitro measure of lymphocyte steroid resistance (DILPA).