Abstract
Aneurysmal subarachnoid hemorrhage (aSAH) is a common cause of death or long-term disability. Despite advances in neurocritical care, there is still only a very limited ability to monitor the development of secondary brain injury or to predict neurological outcome after aSAH. Soluble urokinase-type plasminogen activator receptor (suPAR) has shown potential as a prognostic and as an inflammatory biomarker in a wide range of critical illnesses since it displays an association with overall immune system activation. This is the first time that suPAR has been evaluated as a prognostic biomarker in aSAH. In this prospective population-based study, plasma suPAR levels were measured in aSAH patients (n = 47) for up to 5 days. suPAR was measured at 0, 12, and 24 h after patient admission to the intensive care unit (ICU) and daily thereafter until he/she was transferred from the ICU. The patients' neurological outcome was evaluated with the modified Rankin Scale (mRS) at 6 months after aSAH. suPAR levels (n = 47) during the first 24 h after aSAH were comparable in groups with a favorable (mRS 0-2) or an unfavorable (mRS 3-6) outcome. suPAR levels during the first 24 h were not associated with the findings in the primary brain CT, with acute hydrocephalus, or with antimicrobial medication use during 5-days' follow-up. suPAR levels were associated with generally accepted inflammatory biomarkers (C-reactive protein, leukocyte count). Plasma suPAR level was not associated with either neurological outcome or selected clinical conditions. While suPAR is a promising biomarker for prognostication in several conditions requiring intensive care, it did not reveal any value as a prognostic biomarker after aSAH.
Highlights
Urokinase plasminogen activator receptor (CD87) is present on various immunologically active cells, and its expression becomes elevated by inflammatory conditions and ischemic diseases [1, 2]
No differences were detected in the soluble urokinase-type plasminogen activator receptor (suPAR) levels between those patients presenting with severe (WFNS 4–5) vs. non-severe (WFNS 1–3)
The plasma suPAR concentration during the first 24 h was not associated with the findings from the primary brain CT (Fisher grade) with acute hydrocephalus or with antimicrobial medication during the 5-days’ follow-up (Table 1)
Summary
Urokinase plasminogen activator receptor (uPAR) (CD87) is present on various immunologically active cells, and its expression becomes elevated by inflammatory conditions and ischemic diseases [1, 2]. The soluble form [soluble urokinase-type plasminogen activator receptor (suPAR)] in serum or plasma has emerged as an inflammatory biomarker capable of reflecting overall immune system activation [3, 4]. It has been shown that uPAR expression is induced in cerebral ischemia [5] and traumatic brain injury [6]. SuPAR has been shown to have predictive value in acutely, critically ill patients [9,10,11,12,13], including those who have suffered brain trauma [14]. As far as we are aware, suPAR concentrations have not been evaluated as a prognostic biomarker in patients with subarachnoid hemorrhage
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