Markers of brain injury in patients with aneurysmal subarachnoid hemorrhage

Area of Science:

• Neuroscience
• Neurology
• Biochemistry

Background:

• Cerebral aneurysmal subarachnoid haemorrhage (aSAH) poses a significant risk for developing postoperative cognitive dysfunction (POCD).
• Identifying reliable predictors of POCD is crucial for improving patient outcomes after aSAH surgery.

Purpose of the Study:

• To investigate the correlation between serum changes and cerebrospinal fluid (CSF) brain injury (BI) markers with POCD in aSAH patients.
• To evaluate the predictive value of specific BI markers for POCD development.

Main Methods:

• 120 aSAH patients were assessed 3 months post-surgery using the Montreal Cognitive Assessment (MoCA) scale to classify them into normal cognition or cognitive dysfunction (CD) groups.
• Serum levels of BI markers, including neurofilament-light (NF-L) protein, Ubisquitin C-terminal hydrolase L1 (UCH-L1), Glial Fibrillary Acidic Protein (GFAP), and neuron specific enolase (NSE), were analyzed.
• Correlations between serological changes, BI marker levels, and POCD were statistically analyzed, considering aSAH severity using the Hunt-Hess grading scale.

Main Results:

• Mean levels of NF-L, UCH-L1, GFAP, and NSE were significantly higher in patients with severe aSAH compared to those with mild aSAH.
• The combined prediction of these four BI markers for POCD demonstrated high sensitivity (90.80%), specificity (84.20%), and accuracy (82.80%), outperforming individual marker predictions (p < 0.05).
• The area under the curve (AUC) for the combined prediction was 0.938, indicating a strong predictive performance.

Conclusions:

• BI markers NF-L, UCH-L1, GFAP, and NSE show potential as reliable predictors of POCD in aSAH patients.
• These markers warrant consideration as valuable tools for assessing and managing POCD risk following aSAH.
• Further research can establish reference values for these markers in clinical practice.