A prospective cohort study on serum A20 as a prognostic biomarker of aneurysmal subarachnoid hemorrhage.

BACKGROUND

A20 may be a neuroprotective factor. Herein, we aimed to investigate whether serum A20 levels were associated with disease severity, delayed cerebral ischemia (DCI), and outcome after aneurysmal subarachnoid hemorrhage (aSAH).

METHODS

In this prospective cohort study containing 112 aSAH patients and 112 controls, serum A20 levels were quantified. At 90 d poststroke, Modified Rankin Scale (MRS) scores ≥3 were defined as a poor outcome. All correlations and associations were assessed using multivariate analysis.

RESULTS

Compared with controls, there was a significant elevation of serum A20 levels in patients (median 123.7 pg/mL vs. 25.8 pg/mL; <0.001). Serum A20 levels were independently correlated with Hunt-Hess scores ( 9.854; 95% confidence interval [95% ] 2.481-17.227, =0.009) and modified Fisher scores ( 10.349, 95% 1.273-19.424, =0.026). Independent associations were found between serum A20 levels and poor outcome (odds ratio [] 1.015, 95% 1.000-1.031, =0.047) and DCI ( 1.018, 95% 1.001-1.035, =0.042). Areas under the curve for predicting poor outcome and DCI were 0.771 (95% 0.682-0.845) and 0.777 (95% 0.688-0.850), respectively. Serum A20 levels ≥128.15 pg/mL predicted poor outcome, with a sensitivity of 73.9% and specificity of 74.2%, and A20 levels ≥160.55 pg/mL distinguished the risk of DCI with 65.5% sensitivity and 89.2% specificity. Its ability to predict poor outcome and DCI was similar to those of Hunt-Hess scores and modified Fisher scores (both >0.05).

CONCLUSION

Enhanced serum A20 levels are significantly associated with stroke severity and poor clinical outcome after aSAH, implying that serum A20 may be a potential prognostic biomarker for aSAH.