Department of Biomedical Engineering, Wroclaw University of Science and Technology, Wroclaw, Poland.
Department of Neurosurgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS FT, Birmingham, United Kingdom.
J Clin Neurosci. 2021 May;87:35-43. doi: 10.1016/j.jocn.2021.02.009. Epub 2021 Mar 9.
Identifying patients at risk of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid haemorrhage (aSAH) remains challenging. This study aimed to evaluate the concentration of serum biomarkers along with cerebral autoregulation impairment on DCI.
55 patients suffering from aSAH were enrolled in the study. Serum S100protein B (S100B) was tested both on the day of admission and over three consecutive days following the occurrence of aSAH. Cerebral autoregulation was assessed using a tissue oxygenation index (TOxa) based on near-infrared spectroscopy.
Changes in serum S100B levels interacted with DCI status (presence vs. absence): F = 3.84, p = 0.016. Patients with DCI had higher S100B concentration level on day 3 than those without DCI (3.54 ± 0.50 ng/ml vs. 0.58 ± 0.43 ng/ml, p = 0.001). S100B concentration on day 3 following aSAH predicted DCI (AUC = 0.77, p = 0.006). Raised level of serum S100B on day 3 was related with higher TOxa, thus with impaired cerebral autoregulation (r = 0.52,p = 0.031). Multivariate logistic regression analysis showed thatimpaired cerebral autoregulation andelevatedS100B concentration on day 3 increasethe likelihood of DCI.
Tracking changes in the serum biomarkers concentration along with monitoring of cerebral autoregulation, may play a role in early detection of patients at risk of DCI after aSAH. These results need to be validated in larger prospective cohorts.
识别颅内动脉瘤性蛛网膜下腔出血（aSAH）后迟发性脑缺血（DCI）患者仍然具有挑战性。本研究旨在评估血清生物标志物浓度与脑自动调节功能障碍对 DCI 的影响。
共纳入 55 例 aSAH 患者。在 aSAH 发生后的第一天及连续三天内检测血清 S100 蛋白 B（S100B）浓度。使用近红外光谱仪监测组织氧合指数（TOxa）评估脑自动调节功能。
血清 S100B 水平的变化与 DCI 状态（存在或不存在）相互作用：F=3.84，p=0.016。发生 DCI 的患者第 3 天的 S100B 浓度高于未发生 DCI 的患者（3.54±0.50ng/ml vs. 0.58±0.43ng/ml，p=0.001）。aSAH 后第 3 天的 S100B 浓度可以预测 DCI（AUC=0.77，p=0.006）。第 3 天血清 S100B 水平升高与 TOxa 升高有关，提示脑自动调节功能受损（r=0.52，p=0.031）。多变量逻辑回归分析表明，脑自动调节功能受损和第 3 天 S100B 浓度升高增加了 DCI 的可能性。
监测血清生物标志物浓度变化以及脑自动调节功能监测，可能有助于早期发现 aSAH 后发生 DCI 的高危患者。这些结果需要在更大的前瞻性队列中进一步验证。
