Sajjad Saba, Hewera Michael, Rana Majeed, Gliem Michael, Fischer Igor, Khan Dilaware
Department of Oral, Maxillofacial and Facial Plastic Surgery, University Hospital Düsseldorf, Düsseldorf, Germany.
Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany.
Heliyon. 2024 Nov 20;10(23):e40562. doi: 10.1016/j.heliyon.2024.e40562. eCollection 2024 Dec 15.
Aneurysmal subarachnoid hemorrhage (aSAH) is a highly fatal and morbid disease. Despite successful coiling or clipping of a ruptured aneurysm, the patients suffer post-aSAH complications, including early brain injury, cerebral vasospasm (CVS), delayed cerebral ischemia (DCI), and systemic infections that mainly determine the clinical outcomes. Diagnostic biomarkers to predict accurately post-aSAH complications are needed. In this prospective exploratory study, we investigated the predictive value of neutrophil extracellular traps (NETs) components for CVS after aSAH. In the study, 62 patients with aSAH, 17 patients with unruptured cerebral aneurysms, and 12 healthy controls were included. The serum levels of myeloperoxidase (MPO), elastase (ELA), and citrullinated histone H3 (cH3) on day 1 and day 4 of hospital admission were measured with ELISA. Data were scaled using the Yeo-Johnson transformation. Values in two groups were compared using a -test and in multiple groups using ANOVA. Logistic regression was used to model the outcome probability, including CVS, as the function of ELISA values. Among the patients with aneurysms, those who suffered aSAH had significantly higher levels of MPO (113.9 ± 294.4 vs. 422.3 ± 319.0 ng/ml, p < 0.05), ELA (84.8 ± 221.0 vs. 199.2 ± 218.9 ng/ml, p < 0.05), and cH3 (0.0 ± 0.0 vs. 2.8 ± 1.5, ng/ml, p < 0.05) on day one after aSAH, suggesting the involvement of NETs components in pathophysiology of aSAH and the events following aSAH. Individually, MPO and ELA levels taken on day 1 after SAH did not differ between patients with CVS and patients without CVS. However, when taken together into a logistic model, they allowed for predicting CVS with high sensitivity (91 %) and specificity (79 %). MPO and ELA, along with other clinical parameters, can be used as early predictors of CVS in aSAH patients and can serve as guidance during treatment decisions in the management of aSAH.
动脉瘤性蛛网膜下腔出血（aSAH）是一种致死率和致残率都很高的疾病。尽管已成功对破裂动脉瘤进行了弹簧圈栓塞或夹闭，但患者仍会出现aSAH后并发症，包括早期脑损伤、脑血管痉挛（CVS）、迟发性脑缺血（DCI）以及主要决定临床结局的全身感染。因此需要能够准确预测aSAH后并发症的诊断生物标志物。在这项前瞻性探索性研究中，我们调查了中性粒细胞胞外陷阱（NETs）成分对aSAH后CVS的预测价值。该研究纳入了62例aSAH患者、17例未破裂脑动脉瘤患者和12名健康对照者。入院第1天和第4天采用酶联免疫吸附测定（ELISA）法检测血清髓过氧化物酶（MPO）、弹性蛋白酶（ELA）和瓜氨酸化组蛋白H3（cH3）水平。数据采用Yeo-Johnson变换进行标度。两组间数值比较采用t检验，多组间比较采用方差分析。采用逻辑回归将包括CVS在内的结局概率建模为ELISA值的函数。在动脉瘤患者中，aSAH患者在aSAH后第1天的MPO水平（113.9±294.4 vs. 422.3±319.0 ng/ml，p<0.05）、ELA水平（84.8±221.0 vs. 199.2±218.9 ng/ml，p<0.05）和cH3水平（0.0±0.0 vs. 2.8±1.5 ng/ml，p<0.05）显著更高，这表明NETs成分参与了aSAH的病理生理过程以及aSAH后的相关事件。单独来看，SAH后第1天CVS患者和无CVS患者的MPO和ELA水平并无差异。然而，当将它们纳入逻辑模型时，能够以高敏感性（91%）和特异性（79%）预测CVS。MPO和ELA以及其他临床参数可作为aSAH患者CVS的早期预测指标，并可为aSAH管理中的治疗决策提供指导。
