A multiparameter panel method for outcome prediction following aneurysmal subarachnoid hemorrhage

Intensive Care Med. 2010 Jan;36(1):107-15. doi: 10.1007/s00134-009-1641-y. Epub 2009 Sep 17.

Abstract

Purpose: Accurate early anticipation of long-term irreversible brain damage during the acute phase of patients with aneurysmal subarachnoid hemorrhage (aSAH) remains difficult. Using a combination of clinical scores together with brain injury-related biomarkers (H-FABP, NDKA, UFD1 and S100beta), this study aimed at developing a multiparameter prognostic panel to facilitate early outcome prediction following aSAH.

Methods: Blood samples of 141 aSAH patients from two separated cohorts (sets of 28 and 113 patients) were prospectively enrolled and analyzed with 14 months of delay. Patients were admitted within 48 h following aSAH onset. A venous blood sample was withdrawn within 12 h after admission. H-FABP, NDKA, UFD1, S100beta and troponin I levels were determined using classical immunoassays. The World Federation of Neurological Surgeons (WFNS) at admission and the Glasgow Outcome Score (GOS) at 6 months were evaluated.

Results: In the two cohorts, blood concentration of H-FABP, S100beta and troponin I at admission significantly predicted unfavorable outcome (GOS 1-2-3). A multivariate analysis identified a six-parameter panel, including WFNS, H-FABP, S100beta, troponin I, NDKA and UFD-1; when at least three of these parameters were simultaneously above cutoff values, prediction of unfavorable outcome reached around 70% sensitivity in both cohorts for 100% specificity.

Conclusion: The use of this panel, including four brain injury-related proteins, one cardiac marker and a clinical score, could be a valuable tool to identify aSAH patients at risk of poor outcome.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adaptor Proteins, Vesicular Transport
  • Aged
  • Brain Damage, Chronic / epidemiology
  • Brain Damage, Chronic / etiology
  • Carrier Proteins / metabolism
  • Enzyme-Linked Immunosorbent Assay
  • Fatty Acids / metabolism*
  • Female
  • France
  • Heart / physiology*
  • Humans
  • Male
  • Middle Aged
  • NM23 Nucleoside Diphosphate Kinases / metabolism*
  • Nerve Growth Factors / blood*
  • Neurosurgical Procedures
  • Outcome Assessment, Health Care*
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • Proteins / metabolism*
  • S100 Calcium Binding Protein beta Subunit
  • S100 Proteins / blood*
  • Subarachnoid Hemorrhage / complications
  • Subarachnoid Hemorrhage / diagnosis*
  • Subarachnoid Hemorrhage / surgery
  • Troponin I / blood*

Substances

  • Adaptor Proteins, Vesicular Transport
  • Carrier Proteins
  • Fatty Acids
  • NM23 Nucleoside Diphosphate Kinases
  • Nerve Growth Factors
  • Proteins
  • S100 Calcium Binding Protein beta Subunit
  • S100 Proteins
  • Troponin I
  • UFD1 protein, human