title: The change of plasma pituitary adenylate cyclase-activating polypeptide levels after aneurysmal subarachnoid hemorrhage.
abstract: OBJECTIVE
  Elevated circulating pituitary adenylate cyclase-activating polypeptide (PACAP) levels have been demonstrated to be associated with clinical outcomes of severe traumatic brain injury. The current study aimed to confirm whether elevated plasma PACAP levels are predictive of clinical outcomes of aneurysmal subarachnoid hemorrhage (aSAH).
  
  
  METHODS
  One hundred and eighteen aSAH patients and 118 controls were recruited. Plasma PACAP concentrations were determined using enzyme-linked immunosorbent assay. Patients were followed up until death or completion of 6 months after aSAH. An unfavorable outcome was defined as Glasgow Outcome Scale score of 1-3.
  
  
  RESULTS
  The admission PACAP levels were significantly elevated in all patients (296.6 ± 119.7 pg/ml) compared with controls (77.1 ± 17.9 pg/ml, P < 0.001). Plasma PACAP levels were independently associated with clinical severity indicated by World Federation of Neurological Surgeons (WFNS) score (t = 4.745, P < 0.001) and Fisher score (t = 4.239, P < 0.001) using a multivariate linear regression. PACAP was identified as an independent predictor for 6-month mortality [odds ratio (OR), 1.014; 95% confidence interval (CI), 1.005-1.030; P < 0.001] and 6-month unfavorable outcome (OR, 1.012; 95% CI, 1.006-1.028; P < 0.001) and 6-month overall survival (hazard ratio, 1.016; 95% CI, 1.008-1.023; P < 0.001) using a binary logistic regression analysis and a Cox's proportional hazard analysis, respectively. PACAP had similar predictive values compared with WFNS score and Fisher score according to the receiver operating characteristic curve analysis.
  
  
  CONCLUSIONS
  Higher plasma PACAP levels are associated with clinical severity and long-term prognosis of aSAH patients, and PACAP has potential to be a good prognostic biomarker of aSAH.
authors.affiliation: Department of Neurosurgery, The Hangzhou First People's Hospital, Nanjing Medical University Affiliated Hangzhou Hospital, Hangzhou, China.
authors.forename: L
authors.initials: L
authors.lastname: Jiang
authors.affiliation: Department of Neurosurgery, The Affiliated Zhongda Hospital of Southeast University, Nanjing, China.
authors.forename: W-H
authors.initials: WH
authors.lastname: Wang
authors.affiliation: Department of Neurosurgery, The Hangzhou First People's Hospital, Nanjing Medical University Affiliated Hangzhou Hospital, Hangzhou, China.
authors.forename: X-Q
authors.initials: XQ
authors.lastname: Dong
authors.affiliation: Department of Neurosurgery, The Hangzhou First People's Hospital, Nanjing Medical University Affiliated Hangzhou Hospital, Hangzhou, China.
authors.forename: W-H
authors.initials: WH
authors.lastname: Yu
authors.affiliation: Department of Neurosurgery, The Hangzhou First People's Hospital, Nanjing Medical University Affiliated Hangzhou Hospital, Hangzhou, China.
authors.forename: Q
authors.initials: Q
authors.lastname: Du
authors.affiliation: Department of Neurosurgery, The Hangzhou First People's Hospital, Nanjing Medical University Affiliated Hangzhou Hospital, Hangzhou, China.
authors.forename: D-B
authors.initials: DB
authors.lastname: Yang
authors.affiliation: Department of Neurosurgery, The Hangzhou First People's Hospital, Nanjing Medical University Affiliated Hangzhou Hospital, Hangzhou, China.
authors.forename: H
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Neurosurgery, The Hangzhou First People's Hospital, Nanjing Medical University Affiliated Hangzhou Hospital, Hangzhou, China.
authors.forename: Y-F
authors.initials: YF
authors.lastname: Shen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D051219:Pituitary Adenylate Cyclase-Activating Polypeptide / Q000097:blood*; D013345:Subarachnoid Hemorrhage / Q000097:blood* / Q000473:pathology
chemical_list: D015415:Biomarkers; D051219:Pituitary Adenylate Cyclase-Activating Polypeptide
keywords: intracranial aneurysmal; pituitary adenylate cyclase-activating polypeptide; prognosis; severity; subarachnoid hemorrhage