Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu 514-8507, Japan.
Int J Mol Sci. 2024 Jan 30;25(3):1701. doi: 10.3390/ijms25031701.
Aneurysmal subarachnoid hemorrhage (SAH) has increased with the aging of the population, but the outcome for elderly SAH patients is very poor. Therefore, predicting the outcome is important for determining whether to pursue aggressive treatment. Pigment epithelium-derived factor (PEDF) is a matricellular protein that is induced in the brain, and the plasma levels could be used as a biomarker for the severity of metabolic diseases. This study investigated whether acute-phase plasma PEDF levels could predict outcomes after aneurysmal SAH in the elderly. Plasma samples and clinical variables were collected over 1-3 days, post-SAH, from 56 consecutive elderly SAH patients ≥75 years of age registered in nine regional stroke centers in Japan between September 2013 and December 2016. The samples and variables were analyzed in terms of 3-month outcomes. Acute-phase plasma PEDF levels were significantly elevated in patients with ultimately poor outcomes, and the cutoff value of 12.6 µg/mL differentiated 3-month outcomes with high sensitivity (75.6%) and specificity (80.0%). Acute-phase plasma PEDF levels of ≥12.6 µg/mL were an independent and possibly better predictor of poor outcome than previously reported clinical variables. Acute-phase plasma PEDF levels may serve as the first biomarker to predict 3-month outcomes and to select elderly SAH patients who should be actively treated.
颅内动脉瘤性蛛网膜下腔出血（SAH）随着人口老龄化而增加，但老年 SAH 患者的预后非常差。因此，预测预后对于确定是否进行积极治疗非常重要。色素上皮衍生因子（PEDF）是一种基质细胞蛋白，在大脑中被诱导产生，其血浆水平可用作代谢性疾病严重程度的生物标志物。本研究探讨了急性期血浆 PEDF 水平是否可以预测老年颅内动脉瘤性 SAH 患者的预后。2013 年 9 月至 2016 年 12 月，在日本 9 个地区性卒中中心登记了 56 例年龄≥75 岁的连续老年 SAH 患者，在发病后 1-3 天采集了血浆样本和临床变量。根据 3 个月的结果分析了样本和变量。最终预后不良的患者急性期血浆 PEDF 水平显著升高，12.6μg/ml 的临界值对 3 个月的预后具有较高的敏感性（75.6%）和特异性（80.0%）。急性期血浆 PEDF 水平≥12.6μg/ml 是预后不良的独立且可能更好的预测因素，优于先前报道的临床变量。急性期血浆 PEDF 水平可能成为预测 3 个月预后和选择应积极治疗的老年 SAH 患者的首个生物标志物。
