Serum peroxiredoxin 2 emerges as a predictive biomarker of poor neurological outcome and delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage: a prospective cohort study.

Peroxiredoxin 2 (Prdx2), an oxidative mediator, participates in acute brain injury. Here, serum Prdx2 levels were measured in order to assess its prognostic significance in aneurysmal subarachnoid hemorrhage (aSAH). In this prospective cohort study, serum Prdx2 levels were detected in 100 controls and 161 patients with aSAH. The modified Fisher scale (mFisher) and World Federation of Neurological Surgeons Scale (WFNS) were selected as two severity metrics. Post-aSAH 6-month Glasgow outcome scale (GOS) score of 1-3 was termed as poor prognosis. Poor prognosis and delayed cerebral ischemia (DCI) were chosen as two outcome variables of interest. Severity correlation and prognosis association with serum Prdx2 levels were investigated using multiple factorial approaches. Patients had markedly higher serum Prdx2 levels than controls. Serum Prdx2 levels, in independent correlation with WFNS scores and mFisher scores, were independently associated with DCI, poor prognosis, continuous GOS scores and ordinal GOS scores. Serum Prdx2 levels and two other independent predictors, that is WFNS scores and mFisher scores, were merged to form two models for predicting DCI and poor prognosis respectively. The two models were visually represented via the nomogram, and occupied satisfactory validity, stability and discrimination efficiency under decision curve, calibration curve and receiver operating characteristic curve. Serum Prdx2 levels of substantial promotion after aSAH are firmly linked to severity, DCI and bad 6-month prognosis of patients, strengthening serum Prdx2 as a useful prognostic biomarker of aSAH.