title: Predicting neurological deficit severity due to subarachnoid haemorrhage: soluble CD40 ligand and platelet-derived growth factor-BB.
abstract: BACKGROUND
  Several biological markers can predict outcomes in patients with subarachnoid haemorrhage (SAH), but markers to predict neurological deficit severity in patients with SAH and poor neurological condition have not yet been established. Soluble CD40 ligand (sCD40L) and platelet-derived growth factor (PDGF) are related to the systemic inflammatory response.
  
  
  OBJECTIVE
  In a prospective study, to investigate the relationship between clinical outcomes and blood test results in patients with SAH and severe neurological deficits.
  
  
  METHODS
  We studied 17 patients with Hunt and Hess Grade IV and Fisher Class III neurological deficits who had undergone aneurysmal clipping within 48 hours of onset of SAH. We measured their levels of sCD40L, PDGF-AA, PDGF-AB, PDGF-BB and C-reactive protein (CRP), their white blood cell (WBC) and platelet counts and their body temperature. Blood tests were performed at an early time point (Day 0, the day of the SAH before craniotomy) and at a late time point (Day 10). The modified Rankin Scale (mRS) score of the patients was assessed at Day 60.
  
  
  RESULTS
  Seven patients (41%) were classified as mRS 0-2 (good outcome) and 10 (59%) as mRS 3-5 (poor outcome). The blood levels of sCD40L (P = 0.05), PDGF-BB (P = 0.02) and CRP (P = 0.02), WBC count (P = 0.005) and body temperature (P = 0.01) at the late time point were significantly higher in patients with poor outcomes than in patients with good outcomes.
  
  
  CONCLUSIONS
  Our data suggest that sCD40L, PDGF-BB, WBC count, CRP and body temperature can predict the neurological outcome in patients with SAH and poor neurological condition.
authors.affiliation: Department of Neurosurgery, Iwate Medical University, Morioka, Japan. yokubo@iwate-med.ac.jp.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Kubo
authors.affiliation: Department of Neurosurgery, Iwate Medical University, Morioka, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Koji
authors.affiliation: Department of Neurosurgery, Iwate Medical University, Morioka, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Yoshida
authors.affiliation: Department of Neurosurgery, Iwate Medical University, Morioka, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Ogawa
authors.affiliation: Department of Neurosurgery, Iwate Medical University, Morioka, Japan.
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Ogasawara
mesh_terms: D000077214:Becaplermin; D023201:CD40 Ligand / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020574:Proto-Oncogene Proteins c-sis / Q000097:blood*; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000097:blood* / Q000150:complications* / Q000601:surgery
chemical_list: D020574:Proto-Oncogene Proteins c-sis; D023201:CD40 Ligand; D000077214:Becaplermin