Yu Danfeng, Jiang Fengfeng, Xu Wei, He Pingyou, Chen Feng, Liu Xiaobo, Bao Xiang
Department of Neurosurgery, Jinhua Municipal Central Hospital, Jinhua, 321000, People's Republic of China.
Neuropsychiatr Dis Treat. 2023 Jun 27;19:1463-1476. doi: 10.2147/NDT.S417630. eCollection 2023.
Resolvin D1 (RvD1) possesses anti-inflammatory properties and may be neuroprotective. This study was designed to ascertain the potential role of serum RvD1 in the evaluation of aSAH severity and prognosis of human aneurysmal subarachnoid hemorrhage (aSAH).
In this prospective observational study, serum RvD1 levels were measured in 123 patients with aSAH and in 123 healthy volunteers. Six-month neurological function was assessed using extended Glasgow outcome scale (GOSE). A prognostic prediction model was appraised using a series of evaluative tools, such as a nomogram, receiver operating characteristic (ROC) curve, decision curve, calibration curve, restricted cubic spline, and Hosmer-Lemeshow goodness of fit statistics.
Serum RvD1 levels were markedly lower in patients than in controls (median, 0.54 versus 1.47 ng/mL; P<0.001). Serum RvD1 levels were independently correlated with Hunt-Hess scores (beta, -0.154; 95% confidence interval [CI], -0.198--0.109; VIF, 1.769; P=0.001), modified Fisher scores (beta, -0.066; 95% CI, -0.125--0.006; VIF, 1.567; P=0.031) and 6-month GOSE scores (beta, 1.864; 95% CI, 0.759-2.970; VIF, 1.911; P=0.001) and were independently predictive of a poor prognosis (GOSE scores of 1-4) (odds ratio, 0.137; 95% CI, 0.023-0.817; P=0.029). Serum RvD1 levels significantly distinguished the risk of a worse prognosis, with an area under the ROC curve of 0.750 (95% CI, 0.664-0.824). Using the Youden method, serum RvD1 levels < 0.6 ng/mL was effective in predicting worse prognosis with 84.1% sensitivity and 62.0% specificity. Moreover, the model containing serum RvD1 levels, Hunt-Hess scores and modified Fisher scores was efficient, reliable and beneficial in prognostic prediction using a series of the afore-mentioned evaluative tools.
A decline in serum RvD1 levels following aSAH is closely correlated with illness severity and independently predicts a worse outcome in patients with aSAH, implying that serum RvD1, as a prognostic biomarker of aSAH, may be of clinical value in aSAH.
消退素D1（RvD1）具有抗炎特性，可能具有神经保护作用。本研究旨在确定血清RvD1在评估人类动脉瘤性蛛网膜下腔出血（aSAH）严重程度和预后中的潜在作用。
在这项前瞻性观察研究中，测量了123例aSAH患者和123名健康志愿者的血清RvD1水平。使用扩展格拉斯哥预后量表（GOSE）评估6个月时的神经功能。使用一系列评估工具对预后预测模型进行评估，如列线图、受试者工作特征（ROC）曲线、决策曲线、校准曲线、限制立方样条和Hosmer-Lemeshow拟合优度统计量。
患者血清RvD1水平明显低于对照组（中位数，0.54对1.47 ng/mL；P<0.001）。血清RvD1水平与Hunt-Hess评分（β，-0.154；95%置信区间[CI]，-0.198--0.109；方差膨胀因子[VIF]，1.769；P=0.001）、改良Fisher评分（β，-0.066；95%CI，-0.125--0.006；VIF，1.567；P=0.031）和6个月GOSE评分（β，1.864；95%CI，0.759 - 2.970；VIF，1.911；P=0.001）独立相关，并独立预测预后不良（GOSE评分为1 - 4）（比值比，0.137；95%CI，0.023 - 0.817；P=0.029）。血清RvD1水平显著区分了预后较差的风险，ROC曲线下面积为0.750（95%CI，0.664 - 0.824）。采用约登法，血清RvD1水平<0.6 ng/mL可有效预测预后较差情况，敏感性为84.1%，特异性为62.0%。此外，包含血清RvD1水平、Hunt-Hess评分和改良Fisher评分的模型在使用上述一系列评估工具进行预后预测时是有效、可靠且有益的。
aSAH后血清RvD1水平下降与疾病严重程度密切相关，并独立预测aSAH患者预后较差，这意味着血清RvD1作为aSAH的预后生物标志物，可能在aSAH中具有临床价值。
