Can admission lipoprotein-associated phospholipase A2 predict the symptomatic cerebral vasospasm following aneurysmal subarachnoid hemorrhage?

Chen-Yu Ding,Zhang-Ya Lin,De-Zhi Kang,Shu-Fa Zheng,Han-Pei Cai,Yuan-Xiang Lin,Xiao-Yong Chen,Fang-Yu Wang,Liang-Hong Yu

doi:10.1186/s41016-020-00188-z

Abstract

BackgroundInflammation has been believed to be related to the development of cerebral vasospasm following aneurysmal subarachnoid hemorrhage (aSAH). A potential biomarker for vascular inflammation that is well recognized is the lipoprotein-associated phospholipase A2 (Lp-PLA2). However, whether Lp-PLA2 can predict the occurrence of symptomatic cerebral vasospasm (SCV) in aSAH patients is still unknown. Thus, this study aimed to assess the value of Lp-PLA2 for predicting SCV in patients with aSAH.MethodsBetween March 2017 and April 2018, we evaluated 128 consecutive aSAH patients who were admitted in the First Affiliated Hospital of Fujian Medical University. Their Lp-PLA2 level was obtained within 24 h of the initial bleeding. Factors might be related to SCV were analyzed.ResultsCompared to patients without SCV, those with SCV (9.4%, 12/128) had significantly higher Lp-PLA2 level. Multivariate logistic analysis revealed that worse modified Fisher grade (OR = 10.08, 95% CI = 2.04–49.86, P = 0.005) and higher Lp-PLA2 level (OR = 6.66, 95% CI = 1.33–3.30, P = 0.021) were significantly associated with SCV, even after adjustment for confounders. Based on the best threshold, Lp-PLA2 had a sensitivity of 83.3% and a specificity of 51.7% for predicting SCV, as shown by the receiver operating characteristic curve analysis. In the poor World Federation of Neurosurgical Societies grade patient sub-group, patients with Lp-PLA2 > 200 μg/L had significantly higher SCV rate than that of patients having Lp-PLA2 ≤ 200 μg/L.ConclusionThe admission Lp-PLA2 level might be a helpful predictor for SCV in aSAH.

Highlights

Inflammation has been believed to be related to the development of cerebral vasospasm following aneurysmal subarachnoid hemorrhage
The results showed that both the modified Fisher grade (OR = 10.08, 95% CI = 2.04–49.86, P = 0.005) and the Lipoproteinassociated phospholipase A2 (Lp-PLA2) level (OR = 6.66, 95% CI = 1.33–33.30, P = 0.021) were predictors that are significantly associated with symptomatic cerebral vasospasm (SCV) (Table 2)
It was found that for SCV patients, the predictive performance of LpPLA2 was comparable with the World Federation of Neurosurgical Societies (WFNS) grade and modified Fisher grade, which indicates the potential of the Lp-PLA2 level as a new marker in aneurysmal subarachnoid hemorrhage (aSAH) prognosis

Summary

Introduction

Inflammation has been believed to be related to the development of cerebral vasospasm following aneurysmal subarachnoid hemorrhage (aSAH). Clinical rating scales such as the World Federation of Neurosurgical Societies (WFNS) grade and modified Fisher grade, which are easy to use and have relatively high predictive power, are used for assessing the performance of neurological functions and predicting the occurrence of CV [4,5,6]. These clinical scales are not able to differentiate the physical condition of a patient when the changes are small. There is still an unmet need for reliable biomarkers that could be used for more effective diagnosis and assessment of aSAH [12,13,14] in the clinical setting

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