title: HMGB1 Level in Cerebrospinal Fluid as a Marker of Treatment Outcome in Patients with Acute Hydrocephalus Following Aneurysmal Subarachnoid Hemorrhage.
abstract: BACKGROUND
  Attempts to clarify mechanisms of early brain injury in subarachnoid hemorrhage (SAH) revealed a high-mobility group box 1 (HMGB1) protein involvement in sterile inflammation initiated by aneurysm rupture. This study aims at assessing the prognostic value of HMGB1 in comparison with traditional biomarkers.
  
  
  METHODS
  Ten patients with Fisher grade 4 SAH and acute hydrocephalus underwent endovascular coiling and ventriculostomy. HMGB1 level was measured in cerebrospinal fluid (CSF) samples collected on first, fifth, and 10th day. HMGB1 level in first sample was correlated with treatment outcome assessed in Glasgow outcome scale (GOS) at 3 months. Obtained results were compared with plasma inflammatory markers, clinical grading scales, and imaging grading scales. HMGB1 level in consecutive samples was analyzed in search of concentration trends correlating with patients' outcome.
  
  
  RESULTS
  HMGB1 level in CSF of SAH patients, in contrast to control group, is significantly elevated (P < .001). Good (GOS > 3) and poor (GOS ≤ 3) outcome patients differ significantly in HMGB1 level on admission (P < .01). The strongest correlation to patients' outcome was found for Hunt and Hess scale (R = -.887, P < .01), HMGB1 level (R = -.859, P < .01), and World Federation of Neurological Surgeons scale (R = -.832, P < .01). Constant and high HMGB1 level of 10 ng/mL or more in consecutive CSF samples identifies nonsurvivors.
  
  
  CONCLUSIONS
  HMGB1 protein is elevated in SAH patients. Changes in the concentration of HMGB1 in consecutive samples of the CSF correlate with outcome. Our results encourage further proteomic investigation.
authors.affiliation: Department of Neurosurgery, Poznan University of Medical Sciences, Poznan, Poland. Electronic address: bartosz.sokol@gmail.com.
authors.forename: Bartosz
authors.initials: B
authors.lastname: Sokół
authors.affiliation: Nanobiomedical Centre, Adam Mickiewicz University, Poznan, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Woźniak
authors.affiliation: Department of Neurosurgery, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Roman
authors.initials: R
authors.lastname: Jankowski
authors.affiliation: Nanobiomedical Centre, Adam Mickiewicz University, Poznan, Poland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Jurga
authors.affiliation: Department of Neurosurgery, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Norbert
authors.initials: N
authors.lastname: Wąsik
authors.affiliation: Department of Neurosurgery, Poznan University of Medical Sciences, Poznan, Poland.
authors.forename: Hinna
authors.initials: H
authors.lastname: Shahid
authors.affiliation: Nanobiomedical Centre, Adam Mickiewicz University, Poznan, Poland.
authors.forename: Bartosz
authors.initials: B
authors.lastname: Grześkowiak
mesh_terms: D000368:Aged; D001772:Blood Cell Count; D002097:C-Reactive Protein / Q000378:metabolism; D004621:Embolization, Therapeutic / Q000379:methods*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D015600:Glasgow Coma Scale; D024243:HMGB1 Protein / Q000134:cerebrospinal fluid*; D006801:Humans; D006849:Hydrocephalus / Q000134:cerebrospinal fluid* / Q000209:etiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D013223:Statistics as Topic; D018709:Statistics, Nonparametric; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D016896:Treatment Outcome
chemical_list: D024243:HMGB1 Protein; D005340:Fibrinogen; D002097:C-Reactive Protein
keywords: HMGB1; biomarkers; cerebrospinal fluid; high-mobility group box 1; proteomic; subarachnoid hemorrhage