title: Prognostic value of biochemical markers of brain damage and oxidative stress in post-surgical aneurysmal subarachnoid hemorrhage patients.
abstract: The aim of this study is to determine effective biochemical markers and optimal sampling timing for prediction of neurological prognosis in post-surgical aneurysmal subarachnoid hemorrhage (SAH) patients. Subjects were a sequential group of SAH patients admitted to our centre who underwent aneurysm clipping before Day 3 and who received a cerebrospinal fluid (CSF) drain. CSF samples from 32 patients were collected on Days 3, 7, and 14. Neurological outcome was assessed by neurosurgeons using the Glasgow outcome scale (GOS) at 6 months after onset. CSF levels of neuron-specific enolase (NSE), S100B, and glial fibrillary acidic protein (GFAP) were determined using enzyme-linked immunosorbent assay, and the CSF concentrations of malondialdehyde (MDA) were determined using spectrophotometric assay. In univariate analysis, S100B on Days 3 and 14, GFAP on Days 3 and 7, and MDA on Day 14 were significantly higher in the poor outcome group (GOS 1-4) than in the good outcome group (GOS 5). In multivariate analysis, only MDA on Day 14 was identified as a significant predictor of poor neurological outcome at 6 months after onset. The area under the receiver-operating characteristic (ROC) curve for MDA on Day 14 was 0.841. For a threshold of 0.3 microM, sensitivity and specificity were 0.875 and 0.750, respectively. Our findings suggest that these biochemical markers, especially MDA, show significant promise as predictors of neurological outcome in clinical practice.
authors.affiliation: The Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, 1-1-1, Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan. kouta-ygc@umin.ac.jp
authors.forename: Kotaro
authors.initials: K
authors.lastname: Kaneda
authors.forename: Motoki
authors.initials: M
authors.lastname: Fujita
authors.forename: Susumu
authors.initials: S
authors.lastname: Yamashita
authors.forename: Tadashi
authors.initials: T
authors.lastname: Kaneko
authors.forename: Yoshikatsu
authors.initials: Y
authors.lastname: Kawamura
authors.forename: Tomonori
authors.initials: T
authors.lastname: Izumi
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Tsuruta
authors.forename: Shunji
authors.initials: S
authors.lastname: Kasaoka
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Maekawa
mesh_terms: D000704:Analysis of Variance; D019540:Area Under Curve; D001921:Brain / Q000473:pathology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005904:Glial Fibrillary Acidic Protein / Q000134:cerebrospinal fluid; D006801:Humans; D002532:Intracranial Aneurysm / Q000134:cerebrospinal fluid* / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008315:Malondialdehyde / Q000134:cerebrospinal fluid; D008875:Middle Aged; D009414:Nerve Growth Factors / Q000134:cerebrospinal fluid; D018384:Oxidative Stress; D010751:Phosphopyruvate Hydratase / Q000134:cerebrospinal fluid; D011379:Prognosis; D012372:ROC Curve; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins / Q000134:cerebrospinal fluid; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013053:Spectrophotometry; D013345:Subarachnoid Hemorrhage / Q000134:cerebrospinal fluid* / Q000175:diagnosis* / Q000209:etiology; D013997:Time Factors
chemical_list: D005904:Glial Fibrillary Acidic Protein; D009414:Nerve Growth Factors; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins; C579160:S100B protein, human; D008315:Malondialdehyde; D010751:Phosphopyruvate Hydratase