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Exploration of Risk Factors for Poor Prognosis of Non-Traumatic Non-Aneurysmal Subarachnoid Hemorrhage. Biomolecules 2022; 12:biom12070948. [PMID: 35883504 PMCID: PMC9313218 DOI: 10.3390/biom12070948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/03/2022] [Accepted: 07/04/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Subarachnoid hemorrhage (SAH) is a devastating neurological disease associated with high rates of mortality and disability. Aneurysms are the main cause of non-traumatic subarachnoid hemorrhages. However, non-traumatic non-aneurysmal subarachnoid hemorrhage (naSAH), another clinical type of SAH, has been poorly studied for its prognosis and risk factors. Method and result: We collected demographic and clinical variables for 126 naSAH and 89 aneurysmal subarachnoid hemorrhage (aSAH) patients, including age and gender; hospitalization days; hematological indicators; clinical score scales; past medical history; and personal history. We found that the monocytes in naSAH (0.50 ± 0.26) patients were lower than in aSAH patients (0.60 ± 0.27). The prevalence of diabetes in naSAH (30.2%) patients was higher than in aSAH (14.5%) patients. The naSAH patients were divided into good and poor outcome groups based on the modified Rankin Scale at the 90th day (90-day mRS) after discharge. A univariate analysis showed that there were significant differences in age, white blood cell count (WBC), monocyte count, D-dipolymer, neuron-specific enolase (NSE), random blood glucose (RBG), aspartate transaminase (AST), urea and free triiodothyronine (FT3) between the two groups. A logistic regression showed that aging and high level NSE were independent risk factors for a poor outcome. The predictive ability of age (area under curve (AUC) = 0.71) and NSE (AUC = 0.68) were analyzed by a receiver operating characteristic (ROC) curve. The results of the logistic regression suggested that age, D-dipolymer, NSE, RBG, urea and FT3 distinguished and predicted the prognosis of naSAH. The discriminant analysis of the above variables revealed that the discriminant accuracy was 80.20%. Conclusions: Compared with aSAHs, naSAHs are more likely to occur in patients with diabetes, and the level of monocytes is lower. Moreover, the prognosis of elderly patients with an naSAH is relatively poor, and the level of NSE in the course of the disease also reflects the prognosis. Multivariate comprehensive analysis is helpful to judge the prognosis of patients at a small cost.
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Aineskog H, Johansson C, Nilsson R, Koskinen LOD, Lindvall P. Serum S100B correlates with health-related quality of life and functional outcome in patients at 1 year after aneurysmal subarachnoid haemorrhage. Acta Neurochir (Wien) 2022; 164:2209-2218. [PMID: 35748928 PMCID: PMC9338103 DOI: 10.1007/s00701-022-05272-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/20/2022] [Indexed: 11/29/2022]
Abstract
Background Early, objective prognostication after aneurysmal subarachnoid haemorrhage (aSAH) is difficult. A biochemical marker would be desirable. Correlation has been found between levels of the protein S100 beta (S100B) and outcome after aSAH. Timing and clinical usefulness are under investigation. Methods Eighty-nine patients admitted within 48 h of aSAH were included. Modified ranking scale (mRS), EuroQoL health-related quality of life measure (EQ-5Dindex) and EuroQoL visual analogue scale (EQ-VAS) values were evaluated after 1 year. S100B was measured in blood samples collected at admission and up to day 10. Results S100B correlated significantly with EQ-5Dindex and mRS, but not EQ-VAS at 1 year after aSAH. A receiver operating characteristic analysis for peak S100B values (area under the curve 0.898, 95% confidence interval 0.828–0.968, p < 0.0001), with a cutoff of 0.4 μg/l, yielded 95.3% specificity and 68% sensitivity for predicting unfavourable outcome. Dichotomized S100B (> 0.4 μg/l vs ≤ 0.4 μg/l), age and Hunt and Hess grading scale score (HH) were associated with unfavourable mRS outcome in univariate logistic regression analysis. Dichotomized S100B was the only variable independently correlated with unfavourable mRS outcome in a multivariate logistic regression analysis. Conclusions For the first time, S100B was shown to correlate with mRS and health-related quality of life at 1 year after aSAH. Peak S100B can be used as a prognostic factor for unfavourable outcome measured as dichotomized mRS after aSAH. A peak value cutoff of 0.4 μg/l is suggested. Ethical approval no: 2013/366-31, 4th of February 2014.
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Affiliation(s)
- Helena Aineskog
- Department of Clinical Sciences - Neurosciences, Umeå University, 901 87, Umeå, Sweden.
| | - Conny Johansson
- Department of Clinical Sciences - Neurosciences, Umeå University, 901 87, Umeå, Sweden
| | - Robert Nilsson
- Department of Clinical Sciences - Neurosciences, Umeå University, 901 87, Umeå, Sweden
| | - Lars-Owe D Koskinen
- Department of Clinical Sciences - Neurosciences, Umeå University, 901 87, Umeå, Sweden
| | - Peter Lindvall
- Department of Clinical Sciences - Neurosciences, Umeå University, 901 87, Umeå, Sweden
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Zhao H, Shang F, Qi M, Xu Y, Wang N, Qu X. Related Factors and a Threshold of the Maximum Neuron-Specific Enolase Value Affecting the Prognosis of Patients with Aneurysmal Subarachnoid Hemorrhage. Appl Bionics Biomech 2022; 2022:7596426. [PMID: 35572059 PMCID: PMC9106454 DOI: 10.1155/2022/7596426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/13/2022] [Accepted: 04/19/2022] [Indexed: 11/17/2022] Open
Abstract
Background The prognosis of patients with subarachnoid hemorrhage is influenced by many factors. Neuron-specific enolase (NSE) is a biological marker of neurological damage. This study aimed to determine the related prognostic factors and whether or not the maximum NSE value (NSEmax) has a threshold between good and poor prognosis in aneurysmal subarachnoid hemorrhage (aSAH). Methods A total of 259 patients admitted following aSAH were treated by appropriate methods. Initial neurological severity was evaluated by using the initial Glasgow coma scale and Hunt-Hess grades. NSE plasma concentration was measured during the patient's stay in the neurosurgical intensive care unit, and NSEmax was selected for further study. The primary endpoint of the study was Glasgow outcome score (GOS), which was dichotomized as poor outcome (GOS 1-3) or good outcome (GOS 4-5) at discharge. Results A poor outcome of patients with aSAH at discharge was associated with mild hypothermia treatment, Hunt-Hess grade, rehemorrhagia, neurogenic pulmonary edema, and pneumonia, which were independent risk factors affecting the prognosis of patients. The best threshold of the maximum value of NSE for poor or good prognosis was 26.255 μg/L (specificity 0.908). Conclusions Poor neurological score, pulmonary complications, aneurysm rerupture, and mild hypothermia indicate a poor prognosis. NSEmax>26.255 μg/L is an independent predicting factor of poor neurological outcome at discharge after aSAH. This threshold value could help clinicians make the appropriate decision and prognosis.
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Affiliation(s)
- Hao Zhao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
- National Center for Neurological Disorders, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Feng Shang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
- National Center for Neurological Disorders, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Meng Qi
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
- National Center for Neurological Disorders, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Yueqiao Xu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
- National Center for Neurological Disorders, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Ning Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
- National Center for Neurological Disorders, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Xin Qu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
- National Center for Neurological Disorders, China
- China International Neuroscience Institute (China-INI), Beijing, China
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Balança B, Bouchier B, Ritzenthaler T. The management of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. Rev Neurol (Paris) 2021; 178:64-73. [PMID: 34961603 DOI: 10.1016/j.neurol.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 10/20/2021] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
Abstract
Aneurysmal subarachnoid hemorrhage (SAH) is a rare event affecting relatively young patients therefore leading to a high social impact. The management of SAH follows a biphasic course with early brain injuries in the first 72 hours followed by a phase at risk of secondary deterioration due to delayed cerebral ischemia (DCI) in 20 to 30% patients. Cerebral infarction from DCI is the most preventable cause of mortality and morbidity after SAH. DCI prevention, early detection and treatment is therefore advocated. Formerly limited to the occurrence of vasospasm, DCI is now associated with multiple pathophysiological processes involving for instance the macrocirculation, the microcirculation, neurovascular units, and inflammation. Therefore, the therapeutic targets and management strategies are also evolving and are not only focused on proximal vasospasm. In this review, we describe the current knowledge of DCI pathophysiology. We then discuss the diagnosis strategies that may guide physicians at the bedside with a multimodal approach in the unconscious patient. We will present the prevention strategies that have proven efficient as well as future targets and present the therapeutic approach that is currently being developed when a DCI occurs.
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Affiliation(s)
- B Balança
- Service d'anesthésie réanimation, hospices civils de Lyon, hôpital neurologique, 59, boulevard Pinel, 69500 Bron, France; Équipe TIGER, U1028, UMR5292, centre de recherche en neurosciences de Lyon, université de Lyon, 69500 Bron, France.
| | - B Bouchier
- Service d'anesthésie réanimation, hospices civils de Lyon, hôpital neurologique, 59, boulevard Pinel, 69500 Bron, France
| | - T Ritzenthaler
- Service d'anesthésie réanimation, hospices civils de Lyon, hôpital neurologique, 59, boulevard Pinel, 69500 Bron, France; InserMU1044, INSA-Lyon, CNRS UMR5220, Université Lyon 1, hospices civils de Lyon, université de Lyon CREATIS, Bron cedex, France
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Balança B, Desmurs L, Grelier J, Perret-Liaudet A, Lukaszewicz AC. DAMPs and RAGE Pathophysiology at the Acute Phase of Brain Injury: An Overview. Int J Mol Sci 2021; 22:ijms22052439. [PMID: 33670976 PMCID: PMC7957733 DOI: 10.3390/ijms22052439] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/17/2021] [Accepted: 02/23/2021] [Indexed: 12/14/2022] Open
Abstract
Early or primary injury due to brain aggression, such as mechanical trauma, hemorrhage or is-chemia, triggers the release of damage-associated molecular patterns (DAMPs) in the extracellular space. Some DAMPs, such as S100B, participate in the regulation of cell growth and survival but may also trigger cellular damage as their concentration increases in the extracellular space. When DAMPs bind to pattern-recognition receptors, such as the receptor of advanced glycation end-products (RAGE), they lead to non-infectious inflammation that will contribute to necrotic cell clearance but may also worsen brain injury. In this narrative review, we describe the role and ki-netics of DAMPs and RAGE at the acute phase of brain injury. We searched the MEDLINE database for “DAMPs” or “RAGE” or “S100B” and “traumatic brain injury” or “subarachnoid hemorrhage” or “stroke”. We selected original articles reporting data on acute brain injury pathophysiology, from which we describe DAMPs release and clearance upon acute brain injury, and the implication of RAGE in the development of brain injury. We will also discuss the clinical strategies that emerge from this overview in terms of biomarkers and therapeutic perspectives
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Affiliation(s)
- Baptiste Balança
- Department of Neurological Anesthesiology and Intensive Care Medicine, Hospices Civils de Lyon, Hôpital Pierre Wertheimer, 69500 Bron, France;
- Team TIGER, Lyon Neuroscience Research Centre, Inserm U1028, CNRS UMR 5292, 69500 Bron, France
- Correspondence: ; Tel.: +33-6-2391-0594
| | - Laurent Desmurs
- Clinical Chemistry and Molecular Biology Laboratory, Hospices Civils de Lyon, Hôpital Pierre Wertheimer, 69500 Bron, France; (L.D.); (A.P.-L.)
| | - Jérémy Grelier
- Department of Neurological Anesthesiology and Intensive Care Medicine, Hospices Civils de Lyon, Hôpital Pierre Wertheimer, 69500 Bron, France;
| | - Armand Perret-Liaudet
- Clinical Chemistry and Molecular Biology Laboratory, Hospices Civils de Lyon, Hôpital Pierre Wertheimer, 69500 Bron, France; (L.D.); (A.P.-L.)
- Team BIORAN, Lyon Neuroscience Research Centre, Inserm U1028, CNRS UMR 5292, 69500 Bron, France
| | - Anne-Claire Lukaszewicz
- Department of Neurological Anesthesiology and Intensive Care Medicine, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69003 Lyon, France;
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Megjhani M, Terilli K, Weiss M, Savarraj J, Chen LH, Alkhachroum A, Roh DJ, Agarwal S, Connolly ES, Velazquez A, Boehme A, Claassen J, Choi HA, Schubert GA, Park S. Dynamic Detection of Delayed Cerebral Ischemia: A Study in 3 Centers. Stroke 2021; 52:1370-1379. [PMID: 33596676 DOI: 10.1161/strokeaha.120.032546] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage negatively impacts long-term recovery but is often detected too late to prevent damage. We aim to develop hourly risk scores using routinely collected clinical data to detect DCI. METHODS A DCI classification model was trained using vital sign measurements (heart rate, blood pressure, respiratory rate, and oxygen saturation) and demographics routinely collected for clinical care. Twenty-two time-varying physiological measures were computed including mean, SD, and cross-correlation of heart rate time series with each of the other vitals. Classification was achieved using an ensemble approach with L2-regularized logistic regression, random forest, and support vector machines models. Classifier performance was determined by area under the receiver operating characteristic curves and confusion matrices. Hourly DCI risk scores were generated as the posterior probability at time t using the Ensemble classifier on cohorts recruited at 2 external institutions (n=38 and 40). RESULTS Three hundred ten patients were included in the training model (median, 54 years old [interquartile range, 45-65]; 80.2% women, 28.4% Hunt and Hess scale 4-5, 38.7% Modified Fisher Scale 3-4); 101 (33%) developed DCI with a median onset day 6 (interquartile range, 5-8). Classification accuracy before DCI onset was 0.83 (interquartile range, 0.76-0.83) area under the receiver operating characteristic curve. Risk scores applied to external institution datasets correctly predicted 64% and 91% of DCI events as early as 12 hours before clinical detection, with 2.7 and 1.6 true alerts for every false alert. CONCLUSIONS An hourly risk score for DCI derived from routine vital signs may have the potential to alert clinicians to DCI, which could reduce neurological injury.
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Affiliation(s)
- Murad Megjhani
- Department of Neurology (M.M., K.T., H.C., D.J.R., S.A., A.V., A.B., J.C., S.P.), Columbia University Irving Medical Center, New York
| | - Kalijah Terilli
- Department of Neurology (M.M., K.T., H.C., D.J.R., S.A., A.V., A.B., J.C., S.P.), Columbia University Irving Medical Center, New York
| | - Miriam Weiss
- Department of Neurosurgery, RWTH Aachen University, Germany (M.W., G.A.S.)
| | - Jude Savarraj
- Department of Neurology, McGovern Medical School, UT Health, Houston, TX (J.S., H.A.C.)
| | - Li Hui Chen
- Department of Neurology (M.M., K.T., H.C., D.J.R., S.A., A.V., A.B., J.C., S.P.), Columbia University Irving Medical Center, New York
| | | | - David J Roh
- Department of Neurology (M.M., K.T., H.C., D.J.R., S.A., A.V., A.B., J.C., S.P.), Columbia University Irving Medical Center, New York
| | - Sachin Agarwal
- Department of Neurology (M.M., K.T., H.C., D.J.R., S.A., A.V., A.B., J.C., S.P.), Columbia University Irving Medical Center, New York
| | - E Sander Connolly
- Department of Neurosurgery (E.S.C.), Columbia University Irving Medical Center, New York
| | - Angela Velazquez
- Department of Neurology (M.M., K.T., H.C., D.J.R., S.A., A.V., A.B., J.C., S.P.), Columbia University Irving Medical Center, New York
| | - Amelia Boehme
- Department of Neurology (M.M., K.T., H.C., D.J.R., S.A., A.V., A.B., J.C., S.P.), Columbia University Irving Medical Center, New York
| | - Jan Claassen
- Department of Neurology (M.M., K.T., H.C., D.J.R., S.A., A.V., A.B., J.C., S.P.), Columbia University Irving Medical Center, New York
| | - HuiMahn A Choi
- Department of Neurology, McGovern Medical School, UT Health, Houston, TX (J.S., H.A.C.)
| | - Gerrit A Schubert
- Department of Neurosurgery, RWTH Aachen University, Germany (M.W., G.A.S.)
| | - Soojin Park
- Department of Neurology (M.M., K.T., H.C., D.J.R., S.A., A.V., A.B., J.C., S.P.), Columbia University Irving Medical Center, New York
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Brain-Specific Biomarkers as Mortality Predictors after Aneurysmal Subarachnoid Haemorrhage. J Clin Med 2020; 9:jcm9124117. [PMID: 33419282 PMCID: PMC7766120 DOI: 10.3390/jcm9124117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/05/2020] [Accepted: 12/18/2020] [Indexed: 01/14/2023] Open
Abstract
Aneurysmal subarachnoid haemorrhage (aSAH) is a serious condition with a high mortality and high permanent disability rate for those who survive the initial haemorrhage. The purpose of this study was to investigate markers specific to the central nervous system as potential in-hospital mortality predictors after aSAH. In patients with an external ventricular drain, enolase, S100B, and GFAP levels were measured in the blood and cerebrospinal fluid (CSF) on days 1, 2, and 3 after aSAH. Compared to survivors, non-survivors showed a significantly higher peak of S100B and enolase levels in the blood (S100B: 5.7 vs. 1.5 ng/mL, p = 0.031; enolase: 6.1 vs. 1.4 ng/mL, p = 0.011) and the CSF (S100B: 18.3 vs. 0.9 ng/mL, p = 0.042; enolase: 109.2 vs. 6.1 ng/mL, p = 0.015). Enolase showed the highest level of predictability at 1.8 ng/mL in the blood (AUC of 0.873) and 80.0 ng/mL in the CSF (AUC of 0.889). The predictive ability of S100B was also very good with a threshold of 5.7 ng/mL in the blood (AUC 0.825) and 4.5 ng/mL in the CSF (AUC 0.810). In conclusion, enolase and S100B, but not GFAP, might be suitable as biomarkers for the early prediction of in-hospital mortality after aSAH.
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Predicting the Poor Recovery Risk of Aneurysmal Subarachnoid Hemorrhage: Clinical Evaluation and Management Based on a New Predictive Nomogram. Clin Neurol Neurosurg 2020; 200:106302. [PMID: 33092930 DOI: 10.1016/j.clineuro.2020.106302] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 09/20/2020] [Accepted: 10/11/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To develop and validate a model for identifying the risk factors of poor recovery in patients with aneurysmal subarachnoid hemorrhage (aSAH). METHODS A prediction model was developed using training data obtained from 1577 aSAH patients from multiple centers. The patients were followed for 6 months on average and assessed using the modified Rankin Scale; patient information was collected with a prospective case report form. The least absolute shrinkage and selection operator regression were applied to optimize factor selection for the poor recovery risk model. Multivariable logistic regression, incorporating the factors selected in the previous step, was used for model predictions. Predictive ability and clinical effectiveness of the model were evaluated using C-index, receiver operating characteristic curve, and decision curve analysis. Internal validation was performed using the C-index, taking advantage of bootstrapping validation. RESULTS The predictors included household income per capita, hypertension, smoking, migraine within a week before onset, Glasgow Coma Scale at admission, average blood pressure at admission, modified Fisher score at admission, treatment method, and complications. Our newly developed model made satisfactory predictions; it had a C-index of 0.796 and an area under the receiver operating characteristic curve of 0.784. The decision curve analysis showed that the poor recovery nomogram was of clinical benefit when an intervention was decided at a poor recovery threshold between 2% and 50%. Internal validation revealed a C-index of 0.760. CONCLUSION Our findings indicate that the novel poor recovery nomogram may be conveniently used for risk prediction in aSAH patients. For patients with intracranial aneurysms, migraine needs to be vigilant. Quitting smoking and blood pressure management are also beneficial.
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Significance and Diagnostic Accuracy of Early S100B Serum Concentration after Aneurysmal Subarachnoid Hemorrhage. J Clin Med 2020; 9:jcm9061746. [PMID: 32516898 PMCID: PMC7356310 DOI: 10.3390/jcm9061746] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 05/30/2020] [Accepted: 06/03/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Early brain injuries (EBI) are one of the most important causes of morbidity and mortality after subarachnoid hemorrhage. At admission, a third of patients are unconscious (spontaneously or sedated) and EBI consequences are not evaluable. To date, it is unclear who will still be comatose (with severe EBI) and who will recover (with less severe EBI) once the aneurysm is treated and sedation withdrawn. The objective of the present study was to determine the diagnostic accuracy of S100B levels at hospital admission to identify patients with severe neurological consequences of EBI. Methods: Patients were consecutively included in this prospective blinded observational study. A motor component of the Glasgow coma score under 6 on day 3 was used to define patients with severe neurological consequences of EBI. Results: A total of 81 patients were included: 25 patients were unconscious at admission, 68 were treated by coiling. On day 3, 12 patients had severe consequences of EBI. A maximal S100B value between admission and day 1 had an area under the receiver operating characteristic curve (AUC) of 86.7% to predict severe EBI consequences. In patients with impaired consciousness at admission, the AUC was 88.2%. Conclusion: Early S100B seems to have a good diagnostic value to predict severe EBI. Before claiming the usefulness of S100B as a surrogate marker of EBI severity to start earlier multimodal monitoring, these results must be confirmed in an independent validation cohort.
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Balança B, Dailler F, Boulogne S, Ritzenthaler T, Gobert F, Rheims S, Andre-Obadia N. Diagnostic accuracy of quantitative EEG to detect delayed cerebral ischemia after subarachnoid hemorrhage: A preliminary study. Clin Neurophysiol 2018; 129:1926-1936. [PMID: 30007892 DOI: 10.1016/j.clinph.2018.06.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 04/24/2018] [Accepted: 06/15/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Delayed cerebral ischemia (DCI) is the most important and preventable morbidity cause after subarachnoid hemorrhage (SAH). Therefore, DCI early detection is a major challenge. Yet, neurological examination can be unreliable in poor grade SAH patients. EEG provides information from most superficial cortical area, with ischemia-related changes. This study aims at defining an alpha-theta/delta (AT/D) ratio decrease thresholds to detect DCI. METHODS We used EEG with a montage matching vascular territories (right and left anterior central and posterior) and compared them to follow-up brain imaging. RESULTS 15 SAH patients (Fischer ≥ 3, World Federation of Neurological Surgeons scale ≥4, 9 DCI) were monitored during 6.4 [4-8] days (min = 2d, max = 13d). AT/D changes could follow three different patterns: (1) prolonged or (2) transient decrease and (3) no decrease or progressive increase. A regional 30% decrease outlasting 3.7 h reached 100% sensitivity and 88.9% specificity to detect DCI. Only 22.6% were in a zone of uncertain diagnosis (3.7-8.04 h). These prolonged decreases, with a loss of transient changes, started in cortical areas evolving toward DCI, and preceded intracranial changes when available. CONCLUSION Although this study has a small sample size, prolonged AT/D decrease seems to be a reliable biomarker of DCI. SIGNIFICANCE cEEG changes are likely to precede cerebral infarction and could be useful at the bedside to detect DCI before irreversible damage.
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Affiliation(s)
- B Balança
- Hospices Civils de Lyon, Hôpital Pierre Wertheimer, Department of Anesthesiology and Intensive Care Medicine, Lyon, France; Inserm U1028, CNRS UMR 5292, Lyon Neuroscience Research Centre, Team TIGER, Lyon, France; Université Claude Bernard Lyon 1, Centre Lyonnais d'Enseignement par la Simulation en Santé, SAMSEI, Lyon, France.
| | - F Dailler
- Hospices Civils de Lyon, Hôpital Pierre Wertheimer, Department of Anesthesiology and Intensive Care Medicine, Lyon, France
| | - S Boulogne
- Inserm U1028, CNRS UMR 5292, Lyon Neuroscience Research Centre, Team TIGER, Lyon, France; Hospices Civils de Lyon, Hôpital Pierre Wertheimer, Department of Functional Neurology and Epileptology, Lyon, France
| | - T Ritzenthaler
- Hospices Civils de Lyon, Hôpital Pierre Wertheimer, Department of Anesthesiology and Intensive Care Medicine, Lyon, France; CREATIS, CNRS UMR 5220INSERM U1044, Université Lyon 1, Villeurbanne, France
| | - F Gobert
- Hospices Civils de Lyon, Hôpital Pierre Wertheimer, Department of Anesthesiology and Intensive Care Medicine, Lyon, France; Inserm U1028, CNRS UMR 5292, Lyon Neuroscience Research Centre, Team IMAPCT, Lyon, France
| | - S Rheims
- Inserm U1028, CNRS UMR 5292, Lyon Neuroscience Research Centre, Team TIGER, Lyon, France; Hospices Civils de Lyon, Hôpital Pierre Wertheimer, Department of Functional Neurology and Epileptology, Lyon, France
| | - N Andre-Obadia
- Hospices Civils de Lyon, Hôpital Pierre Wertheimer, Department of Functional Neurology and Epileptology, Lyon, France; Inserm U1028, CNRS UMR 5292, Lyon Neuroscience Research Centre, Team NEUROPAIN, Lyon, France
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Abboud T, Mende KC, Jung R, Czorlich P, Vettorazzi E, Priefler M, Kluge S, Westphal M, Regelsberger J. Prognostic Value of Early S100 Calcium Binding Protein B and Neuron-Specific Enolase in Patients with Poor-Grade Aneurysmal Subarachnoid Hemorrhage: A Pilot Study. World Neurosurg 2017; 108:669-675. [PMID: 28943424 DOI: 10.1016/j.wneu.2017.09.074] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 09/11/2017] [Accepted: 09/13/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND This prospective study was undertaken to investigate the value of early S100 calcium binding protein B (S100B) and neuron-specific enolase (NSE) in prognosticating outcome in patients with poor-grade aneurysmal subarachnoid hemorrhage and to develop a statistical model and cutoff values for clinical practice. METHODS Between 2012 and 2014, patients with poor-grade subarachnoid hemorrhage (Hunt and Hess grade 3-5) who were admitted within 24 hours after hemorrhage were prospectively enrolled. Serum NSE and S100B levels were assayed once daily during the first 3 days after hemorrhage. Patient characteristics, Glasgow Coma Scale score, Hunt and Hess grade, and Fisher grade at admission were recorded. Glasgow Outcome Scale (GOS) score was obtained at 6 months and dichotomized as poor (score 1-3) or good (score 4-5). Logistic regression and receiver operating characteristic curve were used to assess the value of S100B and NSE in predicting outcome, and cutoff values were calculated using conditional interference trees. RESULTS The study included 52 patients. Hunt and Hess grade was 3 in 23 patients, 4 in 15 patients, and 5 in 14 patients. S100B range was 0.07-5.62 μg/L (mean 0.87 μg/L ± 1.06). NSE range was 5.7-94.2 μg/L (mean 16.1 μg/L ± 10.5). At 6-month follow-up, 23 patients (44.2%) had a poor outcome, and 29 patients (55.8%) had a good outcome. Both S100B at day 1 (P = 0.004; cutoff 0.202 μg/L) and NSE at day 1 (P = 0.047; cutoff 9.4 μg/L) predicted good outcome with a specificity of 100%. The specificity of mean S100B in detecting patients with poor outcome reached 100% (P = 0.003) when combined with mean NSE levels. CONCLUSIONS S100B and NSE measured during the first 3 days after hemorrhage showed, separately and combined, a significant predictive value in prognosticating clinical outcome in patients with poor-grade subarachnoid hemorrhage. A multicenter study with a large patient cohort is necessary to validate the above-mentioned cutoff values for clinical practice.
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Affiliation(s)
- Tammam Abboud
- Department of Neurosurgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Department of Neurosurgery, University Medical Centre Göttingen, Göttingen, Germany.
| | - Klaus Christian Mende
- Department of Neurosurgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Roman Jung
- Department of Clinical Chemistry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Patrick Czorlich
- Department of Neurosurgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Eik Vettorazzi
- Department of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Marion Priefler
- Department of Intensive Care, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Kluge
- Department of Intensive Care, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Regelsberger
- Department of Neurosurgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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12
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Shi S, Wang G, Zhang K, Zhang Z, Liang K, Li K, Li W, Zhai S. Expression of S100β protein in patients with vascular dementia after basal ganglia hemorrhage and its clinical significance. Exp Ther Med 2017; 13:1917-1921. [PMID: 28565786 PMCID: PMC5443242 DOI: 10.3892/etm.2017.4207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 02/02/2017] [Indexed: 11/05/2022] Open
Abstract
We investigated the expression levels and clinical significance of S100β protein in patients with vascular dementia (VD) after basal ganglia hemorrhage. From June 2014 to December 2015, in 138 patients with basal ganglia hemorrhage, we carried out the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) in patients on the day before the operation, the day after the operation and 9 days after the operation. Thirty-two patients (blood vessel group) had cognitive dysfunction and 106 patients (control group) had VD. One hundred thirty-eight cases of healthy adult volunteers were treated in Henan Provincial People's Hospital and were selected in the same period as healthy controls. The expression levels of serum S100β in the three groups were tested through the ELISA method and the statistical analysis was carried out. In VD patients, the serum S100β levels of patients were significantly higher than VD and healthy control groups; differences were statistically significant (P<0.05). However, there was no significant difference between those without VD after operation and the healthy control group (P>0.05). The correlation analysis was carried out with serum S100β as an independent variable and mean arterial pressure, BMI, MMSE and MoCA scores as dependent variables. Our results suggest that S100β expression levels were negatively correlated to the MMSE score (rs=-4.19) and the difference was statistically significant (P<0.05). The length of hospital stay of patients with basal ganglia hemorrhage associated with VD was significantly extended, with a mean of 23.4±2.8 days. The expression levels of S100β protein in the serum of patients with VD after basal ganglia hemorrhage was significantly increased and negatively correlated to the cognitive function of patients. Therefore, it can be used as a differential diagnosis indicator of VD after the basal ganglia hemorrhage and treatment target point of the VD.
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Affiliation(s)
- Shuaitao Shi
- Interventional Therapy Center, Henan Provincial People's Hospital, Zhengzhou, Henan 450003, P.R. China
| | - Guoquan Wang
- Interventional Therapy Center, Henan Provincial People's Hospital, Zhengzhou, Henan 450003, P.R. China
| | - Kewei Zhang
- Interventional Therapy Center, Henan Provincial People's Hospital, Zhengzhou, Henan 450003, P.R. China
| | - Zhidong Zhang
- Interventional Therapy Center, Henan Provincial People's Hospital, Zhengzhou, Henan 450003, P.R. China
| | - Kai Liang
- Interventional Therapy Center, Henan Provincial People's Hospital, Zhengzhou, Henan 450003, P.R. China
| | - Kun Li
- Interventional Therapy Center, Henan Provincial People's Hospital, Zhengzhou, Henan 450003, P.R. China
| | - Weixiao Li
- Interventional Therapy Center, Henan Provincial People's Hospital, Zhengzhou, Henan 450003, P.R. China
| | - Shuiting Zhai
- Interventional Therapy Center, Henan Provincial People's Hospital, Zhengzhou, Henan 450003, P.R. China
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13
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O'Bryant SE, Mielke MM, Rissman RA, Lista S, Vanderstichele H, Zetterberg H, Lewczuk P, Posner H, Hall J, Johnson L, Fong YL, Luthman J, Jeromin A, Batrla-Utermann R, Villarreal A, Britton G, Snyder PJ, Henriksen K, Grammas P, Gupta V, Martins R, Hampel H. Blood-based biomarkers in Alzheimer disease: Current state of the science and a novel collaborative paradigm for advancing from discovery to clinic. Alzheimers Dement 2017; 13:45-58. [PMID: 27870940 PMCID: PMC5218961 DOI: 10.1016/j.jalz.2016.09.014] [Citation(s) in RCA: 192] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 09/27/2016] [Indexed: 11/25/2022]
Abstract
The last decade has seen a substantial increase in research focused on the identification of blood-based biomarkers that have utility in Alzheimer's disease (AD). Blood-based biomarkers have significant advantages of being time- and cost-efficient as well as reduced invasiveness and increased patient acceptance. Despite these advantages and increased research efforts, the field has been hampered by lack of reproducibility and an unclear path for moving basic discovery toward clinical utilization. Here we reviewed the recent literature on blood-based biomarkers in AD to provide a current state of the art. In addition, a collaborative model is proposed that leverages academic and industry strengths to facilitate the field in moving past discovery only work and toward clinical use. Key resources are provided. This new public-private partnership model is intended to circumvent the traditional handoff model and provide a clear and useful paradigm for the advancement of biomarker science in AD and other neurodegenerative diseases.
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Affiliation(s)
- Sid E O'Bryant
- Institute for Healthy Aging, University of North Texas Health Science Center, Fort Worth, TX, USA.
| | - Michelle M Mielke
- Department of Neurology, Mayo Clinic, Rochester, MN, USA; Department of Health Science Research, Mayo Clinic, Rochester, MN, USA
| | - Robert A Rissman
- Alzheimer's Disease Cooperative Study, Department of Neurosciences, UCSD School of Medicine, La Jolla, CA, USA
| | - Simone Lista
- AXA Research Fund and UPMC Chair, Paris, France; Department de Neurologie, Institut de la Memorie et de la Maladie d'Alzheimer (IM2A) et Institut du Cerveau et du la Moelle epiniere (ICM), Hospital de la Pitie-Salpetriere, Sorbonne Universites, Universite Pierre et Marie Curie, Paris, France
| | | | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gotenburg, Molndal, Sweden; UCL Institute of Neurology, London, UK
| | - Piotr Lewczuk
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Erlangen and Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Neurodegeneration Diagnostics, Medical University of Bialystok, Bialystok, Poland
| | | | - James Hall
- Institute for Healthy Aging, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Leigh Johnson
- Institute for Healthy Aging, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Yiu-Lian Fong
- Johnson & Johnson, London Innovation Center, London, UK
| | - Johan Luthman
- Neuroscience Clinical Development, Clinical Neuroscience Eisai, Woodcliff Lake, NJ, USA
| | | | | | - Alcibiades Villarreal
- Centro de Neurociencias y Unidad de Investigacion Clinica, Instituto de Investigaciones Cientificas y Servicios de Alta Tecnologia (INDICASAT AIP), Ciudad del Saber, Panama, Panama
| | - Gabrielle Britton
- Centro de Neurociencias y Unidad de Investigacion Clinica, Instituto de Investigaciones Cientificas y Servicios de Alta Tecnologia (INDICASAT AIP), Ciudad del Saber, Panama, Panama
| | - Peter J Snyder
- Department of Neurology, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, RI, USA
| | - Kim Henriksen
- Neurodegenerative Diseases, Nordic Bioscience Biomarkers and Research, Herlev, Denmark
| | - Paula Grammas
- George and Anne Ryan Institute for Neuroscience, University of Rhode Island, RI, USA
| | - Veer Gupta
- Faculty of Health, Engineering and Sciences, Center of Excellence for Alzheimer's Disease Research and Care, School of Medical Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Ralph Martins
- Faculty of Health, Engineering and Sciences, Center of Excellence for Alzheimer's Disease Research and Care, School of Medical Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Harald Hampel
- AXA Research Fund and UPMC Chair, Paris, France; Department de Neurologie, Institut de la Memorie et de la Maladie d'Alzheimer (IM2A) et Institut du Cerveau et du la Moelle epiniere (ICM), Hospital de la Pitie-Salpetriere, Sorbonne Universites, Universite Pierre et Marie Curie, Paris, France
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14
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Ding YS, Sun B, Jiang JX, Zhang Q, Lu J, Gao GZ. Increased serum concentrations of signal peptide-Cub-Egf domain-containing protein-1 in patients with aneurysmal subarachnoid hemorrhage. Clin Chim Acta 2016; 459:117-122. [DOI: 10.1016/j.cca.2016.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 04/26/2016] [Accepted: 06/02/2016] [Indexed: 02/07/2023]
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