title: Haptoglobin phenotype predicts cerebral vasospasm and clinical deterioration after aneurysmal subarachnoid hemorrhage.
abstract: Vasospasm (VS) and delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) are thought to greatly affect prognosis. Haptoglobin (Hp) is a hemoglobin-binding protein expressed by a genetic polymorphism (1-1, 2-1, and 2-2). Our objects were to investigate whether the Hp phenotype could predict the incidence of cerebral infarction, favorable outcome, clinical deterioration by DCI, and angiographical VS after aneurysmal SAH. Ninety-five consecutive patients who underwent clipping or coil embolization were studied. Favorable functional outcome was defined as a modified Rankin Scale score of 0-2 at 3 months. Angiographical VS was diagnosed based on cerebral angiography findings performed between days 7 and 10 after SAH. The Hp 2-2 group had a significantly greater risk of angiographical VS than that of Hp 2-1 and 1-1 groups combined on univariate (odds ratio [OR]: 3.60, confidence interval [CI]: 1.49-8.67, P = .003) and multivariate logistic regression analyses after being adjusted for age, sex, Fisher groups, and other risk factors (OR: 3.75, CI: 1.54-9.16, P = .004). The Hp 2-2 group also showed the tendency of a greater risk of clinical deterioration by DCI with marginal significance on univariate and age- and sex-adjusted analyses (univariate OR: 2.46, CI: .90-6.74, P = .080; age- and sex-adjusted OR: 2.46, CI: .89-6.82, P = .080) but not after being adjusted for other multiple risk factors. The Hp 2-2 group was not associated with the favorable 3-month outcome and cerebral infarction (univariate: P = .867, P = .209; multivariate: P = .905, P = .292). The Hp phenotype seems to be associated with a higher rate of angiographical VS and clinical deterioration by DCI but does not affect the incidence of cerebral infarction and favorable outcome.
authors.affiliation: Department of Neurosurgery, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ohnishi
authors.forename: Koji
authors.initials: K
authors.lastname: Iihara
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Kaku
authors.forename: Keita
authors.initials: K
authors.lastname: Yamauchi
authors.forename: Kenji
authors.initials: K
authors.lastname: Fukuda
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Nishimura
authors.forename: Michikazu
authors.initials: M
authors.lastname: Nakai
authors.forename: Tetsu
authors.initials: T
authors.lastname: Satow
authors.forename: Norio
authors.initials: N
authors.lastname: Nakajima
authors.forename: Masaya
authors.initials: M
authors.lastname: Ikegawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002533:Cerebral Angiography; D002544:Cerebral Infarction / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D016009:Chi-Square Distribution; D004185:Disability Evaluation; D005260:Female; D006242:Haptoglobins / Q000032:analysis*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010641:Phenotype; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D013997:Time Factors; D020301:Vasospasm, Intracranial / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D055815:Young Adult
chemical_list: D015415:Biomarkers; C485359:HP protein, human; D006242:Haptoglobins