title: Serum caspase-cleaved cytokeratin-18 levels and outcomes after aneurysmal subarachnoid hemorrhage.
abstract: OBJECTIVE
  Cell apoptosis is involved in acute brain injury after aneurysmal subarachnoid hemorrhage (aSAH). The protein cytokeratin-18 (CK-18) is cleaved by the action of caspases during apoptosis, and the resulting fragments are released into the blood as caspase-cleaved CK (CCCK)-18. Our study examined the relationship between circulating CCCK-18 levels and long-term clinical outcomes among aSAH patients.
  
  
  METHODS
  We recruited 128 aSAH patients and 128 controls (matched on age and sex). Serum was collected at admission to the emergency department. Unfavorable outcome was defined as the Glasgow Outcome Score scores of 1-3. After a 6-month follow-up period, outcomes were assessed using a logistic regression analyses. The prognostic predictive values were evaluated according to receiver operating curves analysis.
  
  
  RESULTS
  aSAH patients had higher plasma CCCK-18 levels compared to controls (235.1 ± 86.8 U/L vs. 25.6 ± 23.4 U/L, P<0.001). CCCK-18 was independently associated with World Federation of Neurological Surgeons (WFNS) scores (t=4.460, P<0.001) and modified Fisher scores (t=3.781, P<0.001). Furthermore, CCCK-18 levels were markedly higher among patients with an unfavorable outcome and among non-survivors. CCCK-18 was yet identified as an independent prognostic predictor for mortality (odds ratio, 5.769; 95% confidence interval, 1.196-27.832; P=0.029) and unfavorable outcome (odds ratio, 4.909; 95% confidence interval, 1.521-15.838; P=0.008), as well as had similar predictive values for them compared with WFNS scores and modified Fisher scores.
  
  
  CONCLUSIONS
  High circulating CCCK-18 levels were associated with injury severity and a poor clinical outcome after aSAH and CCCK-18 had the potential to be a good prognostic biomarker for aSAH.
authors.affiliation: Department of Neurosurgery, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, 568 Zhongxing North Road, Shaoxing 312000, Zhejiang Province, China.
authors.forename: Zi-Gang
authors.initials: ZG
authors.lastname: Yuan
authors.affiliation: Department of Neurosurgery, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, 568 Zhongxing North Road, Shaoxing 312000, Zhejiang Province, China. Electronic address: sxwjlszg@163.com.
authors.forename: Jian-Li
authors.initials: JL
authors.lastname: Wang
authors.affiliation: Department of Neurosurgery, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, 568 Zhongxing North Road, Shaoxing 312000, Zhejiang Province, China.
authors.forename: Guo-Liang
authors.initials: GL
authors.lastname: Jin
authors.affiliation: Department of Neurosurgery, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, 568 Zhongxing North Road, Shaoxing 312000, Zhejiang Province, China.
authors.forename: Xue-Bin
authors.initials: XB
authors.lastname: Yu
authors.affiliation: Department of Neurosurgery, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, 568 Zhongxing North Road, Shaoxing 312000, Zhejiang Province, China.
authors.forename: Jin-Quan
authors.initials: JQ
authors.lastname: Li
authors.affiliation: Department of Neurosurgery, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, 568 Zhongxing North Road, Shaoxing 312000, Zhejiang Province, China.
authors.forename: Tian-Lun
authors.initials: TL
authors.lastname: Qiu
authors.affiliation: Department of Neurosurgery, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, 568 Zhongxing North Road, Shaoxing 312000, Zhejiang Province, China.
authors.forename: Rong-Xiao
authors.initials: RX
authors.lastname: Dai
mesh_terms: D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D053538:Keratin-18 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012372:ROC Curve; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000097:blood*; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: C488421:KRT18 protein, human; D053538:Keratin-18
keywords: Aneurysm; Biomarker; Caspase-cleaved cytokeratin-18; Functional outcome; Mortality; Prognosis; Subarachnoid hemorrhage