Sun Zhongbo, Li Yaqiang, Chang Fu, Jiang Ke
Department of Neurosurgery, First Affiliated Hospital of Anhui University of Science and Technology (First People's Hospital of Huainan), Huainan, China.
Department of Neurology, People's Hospital of Lixin County, Bozhou, China.
Front Neurol. 2023 Jan 12;13:1099391. doi: 10.3389/fneur.2022.1099391. eCollection 2022.
Inflammation plays a vital role in the aneurysmal subarachnoid hemorrhage (aSAH), while serum amyloid A (SAA) has been identified as an inflammatory biomarker. The present study aimed to elucidate the relationship between SAA concentrations and prognosis in aSAH.
From prospective analyses of patients admitted to our department between March 2016 and August 2022, aSAH patients with complete medical records were evaluated. Meanwhile, the healthy control group consisted of the age and sex matched individuals who came to our hospital for healthy examination between March 2018 and August 2022. SAA level was measured by enzyme-linked immunosorbent assay kit (Invitrogen Corp). The Glasgow Outcome Scale (GOS) was used to classify patients into good (GOS score of 4 or 5) and poor (GOS score of 1, 2, or 3) outcome.
456 patients were enrolled in the study, thereinto, 200 (43.86%) patients had a poor prognosis at the 3-months follow-up. Indeed, the SAA of poor outcome group were significantly increased compared to good outcome group and healthy control group [36.44 (32.23-41.00) vs. 28.99 (14.67-34.12) and 5.64 (3.43-7.45), < 0.001]. In multivariate analyses, SAA served for independently predicting the poor outcome after aICH at 3 months [OR:1.129 (95% CI, 1.081-1.177), < 0.001]. After adjusting the underlying confounding factors, the odds ratio (OR) of depression after aSAH was 2.247 (95% CI: 1.095-4.604, = 0.021) for the highest tertile of SAA relative to the lowest tertile. With an AUC of 0.807 (95% CI, 0.623-0.747), SAA demonstrated an obviously better discriminatory ability relative to CRP, WBC, and IL-6. SAA as an indicator for predicting poor outcome after aSAH had an optimal cut-off value of 30.28, and the sensitivity and specificity were 61.9 and 78.7%, respectively.
Elevated level of SAA was associated with poor outcome at 3 months, suggesting that SAA might be a useful inflammatory markers to predict prognosis after aSAH.
炎症在动脉瘤性蛛网膜下腔出血（aSAH）中起重要作用，而血清淀粉样蛋白A（SAA）已被确定为一种炎症生物标志物。本研究旨在阐明aSAH患者SAA浓度与预后之间的关系。
对2016年3月至2022年8月在我科住院的患者进行前瞻性分析，评估病历完整的aSAH患者。同时，健康对照组由2018年3月至2022年8月来我院进行健康体检的年龄和性别匹配的个体组成。采用酶联免疫吸附测定试剂盒（Invitrogen公司）测量SAA水平。采用格拉斯哥预后量表（GOS）将患者分为预后良好（GOS评分为4或5）和预后不良（GOS评分为1、2或3）。
本研究共纳入456例患者，其中200例（43.86%）患者在3个月随访时预后不良。事实上，预后不良组的SAA水平显著高于预后良好组和健康对照组[36.44（32.23 - 41.00） vs. 28.99（14.67 - 34.12）和5.64（3.43 - 7.45），P < 0.001]。在多因素分析中，SAA可独立预测aICH后3个月的不良预后[OR：1.129（95%CI，1.081 - 1.177），P < 0.001]。在调整潜在混杂因素后，相对于最低三分位数，SAA最高三分位数的aSAH患者发生抑郁的比值比（OR）为2.247（95%CI：1.095 - 4.604，P = 0.021）。SAA的曲线下面积（AUC）为0.807（95%CI，0.623 - 0.747），相对于CRP、WBC和IL - 6，其具有明显更好的鉴别能力。SAA作为预测aSAH后不良预后的指标，最佳截断值为30.28时，敏感性和特异性分别为61.9%和78.7%。
SAA水平升高与3个月时的不良预后相关，提示SAA可能是预测aSAH后预后的有用炎症标志物。
