Abstract
Aneurysmal subarachnoid haemorrhage (aSAH) is a serious condition with a high mortality and high permanent disability rate for those who survive the initial haemorrhage. The purpose of this study was to investigate markers specific to the central nervous system as potential in-hospital mortality predictors after aSAH. In patients with an external ventricular drain, enolase, S100B, and GFAP levels were measured in the blood and cerebrospinal fluid (CSF) on days 1, 2, and 3 after aSAH. Compared to survivors, non-survivors showed a significantly higher peak of S100B and enolase levels in the blood (S100B: 5.7 vs. 1.5 ng/mL, p = 0.031; enolase: 6.1 vs. 1.4 ng/mL, p = 0.011) and the CSF (S100B: 18.3 vs. 0.9 ng/mL, p = 0.042; enolase: 109.2 vs. 6.1 ng/mL, p = 0.015). Enolase showed the highest level of predictability at 1.8 ng/mL in the blood (AUC of 0.873) and 80.0 ng/mL in the CSF (AUC of 0.889). The predictive ability of S100B was also very good with a threshold of 5.7 ng/mL in the blood (AUC 0.825) and 4.5 ng/mL in the CSF (AUC 0.810). In conclusion, enolase and S100B, but not GFAP, might be suitable as biomarkers for the early prediction of in-hospital mortality after aSAH.
Highlights
In patients who have suffered brain injury, the concentrations of certain markers in the cerebrospinal fluid (CSF) and blood are correlated with the severity of brain damage and the outcome [1,2,3]
Markers specific to the central nervous system (CNS) have been the focus of research as potential post-injury outcome biomarkers, in particular those derived from neurons and astrocytes [4]
S100B is released after brain injury and high levels of S100B can be detected in a variety of pathological injuries to the CNS, such as subarachnoid haemorrhage (SAH), acute brain injury, traumatic brain injury (TBI), and acute ischemic stroke [5,6]
Summary
In patients who have suffered brain injury, the concentrations of certain markers in the cerebrospinal fluid (CSF) and blood are correlated with the severity of brain damage and the outcome [1,2,3]. Markers specific to the central nervous system (CNS) have been the focus of research as potential post-injury outcome biomarkers, in particular those derived from neurons and astrocytes [4]. NSE has the potential to be useful as a marker of destructive processes in the central nervous system. Another marker, S100B, is a protein found predominantly in astrocytes, glial and Schwann cells in the CNS. Glial fibrillary acid protein (GFAP), a cytoskeleton protein, is another promising marker of brain injury. It serves as an intermediate filament in numerous cell types of the CNS, including mature astrocytes. The concentration of GFAP is higher in brain pathologies such as stroke, intracerebral haemorrhage, dementia, and SAH [7]
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