Kedziora Jaroslaw, Burzynska Malgorzata, Gozdzik Waldemar, Kübler Andrzej, Uryga Agnieszka, Kasprowicz Magdalena, Adamik Barbara
Department of Anesthesiology and Intensive Therapy, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland.
Department of Biomedical Engineering, Wroclaw University of Science and Technology, 50-370 Wroclaw, Poland.
J Clin Med. 2020 Dec 20;9(12):4117. doi: 10.3390/jcm9124117.
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, = 0.031; enolase: 6.1 vs. 1.4 ng/mL, = 0.011) and the CSF (S100B: 18.3 vs. 0.9 ng/mL, = 0.042; enolase: 109.2 vs. 6.1 ng/mL, = 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.
动脉瘤性蛛网膜下腔出血（aSAH）是一种严重疾病，对于在初次出血后存活下来的患者，其死亡率高且永久性残疾率高。本研究的目的是调查中枢神经系统特异性标志物作为aSAH后潜在的院内死亡预测指标。对于有脑室外引流的患者，在aSAH后第1、2和3天测量血液和脑脊液（CSF）中的烯醇化酶、S100B和胶质纤维酸性蛋白（GFAP）水平。与幸存者相比，非幸存者血液中S100B和烯醇化酶水平的峰值显著更高（S100B：5.7 vs. 1.5 ng/mL，P = 0.031；烯醇化酶：6.1 vs. 1.4 ng/mL，P = 0.011），脑脊液中也是如此（S100B：18.3 vs. 0.9 ng/mL，P = 0.042；烯醇化酶：109.2 vs. 6.1 ng/mL，P = 0.015）。烯醇化酶在血液中1.8 ng/mL时预测能力最高（曲线下面积[AUC]为0.873），在脑脊液中80.0 ng/mL时预测能力最高（AUC为0.889）。S100B的预测能力也非常好，血液中的阈值为5.7 ng/mL（AUC 0.825），脑脊液中的阈值为4.5 ng/mL（AUC 0.810）。总之，烯醇化酶和S100B，而非GFAP，可能适合作为aSAH后院内死亡早期预测的生物标志物。
