Abstract
Aneurysmal subarachnoid hemorrhage is a devastating condition, often leading to a debilitating outcome. Delayed ischemic neurological deficits are considered the feared sequelae. Proteomics is a large-scale study of proteins incorporating structural and functional properties in complex biological fluids. Analysis of proteomes has led to identifying relevant complex proteins related to specific pathophysiological processes reflecting the severity and extent of diseases. Proteomics has evolved in the past few years; more biomarkers are deemed clinically relevant to diagnose, monitor, and define prognosis in patients with aneurysmal subarachnoid hemorrhage. Despite the absence of candidate biomarkers in the clinical routine, many have shown promising results. The complexity of proteins implicated in aneurysmal subarachnoid hemorrhage rendered these biomarkers' clinical use paved with various pitfalls and technical difficulties, especially when data about the perfect timing and values are lacking. We review the latest literature concerning serum proteomics and their clinical utility regarding the prediction of cerebral vasospasm and other complications of aneurysmal subarachnoid hemorrhage, as well as the clinical outcome. Future prospective studies will allow changing the disease's course, label patients according to their prognosis to provide earlier and better management and improve outcomes.
Highlights
Among the vast etiologies of strokes, aneurysmal subarachnoid hemorrhage accounts for about 2-5% of all stroke cases (Lovelock et al, 2010)
delayed cerebral ischemia (DCI) is the main predictor of clinical outcome in aneurysmal subarachnoid hemorrhage (aSAH) and was believed to come secondary to cerebral vasospasm (CVS) in 20-30% of cases (Haley et al, 1992)
Tawk et al (2016) and colleagues involved 309 patients. They found that Neuron-specific enolase (NSE) level > 15 ng/mL is considered relatively high and significantly associated with higher World Federation of Neurological Surgeons (WFNS) score, GCS, and Hunt & Hess (H&H) grade, concluding that NSE can be a potential predictor for poor outcome in aSAH
Summary
Among the vast etiologies of strokes, aneurysmal subarachnoid hemorrhage (aSAH) accounts for about 2-5% of all stroke cases (Lovelock et al, 2010). Endothelin receptor antagonist (ETRA) showed the promising result to prevent CVS but failed to show a benefit in term of mortality and neurological outcomes (Kramer and Fletcher, 2009; Ma et al, 2012; Macdonald et al, 2011; Vergouwen et al, 2012), which suggests that additional factors contribute to clinical deterioration and DCI, the main predictor of outcome. This strongly challenges the concept that angiographic vasospasm is the predominant factor for DCI. This emphasizes the various etiologies of DCI rather than to be narrowed down to CVS
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