A multiparameter panel method for outcome prediction following aneurysmal subarachnoid hemorrhage

Turck, Natacha; Vutskits, László; Sanchez-Peña, Paola; Robin, Xavier; Hainard, Alexandre; Gex‐Fabry, Marianne; Fouda, Catherine; Bassem, Hadiji; Mueller, Markus; Lisacek, Frédérique; Puybasset, Louis; Sanchez, Jean‐Charles

doi:10.1007/s00134-009-1641-y

Cited by 80 publications

(50 citation statements)

References 42 publications

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“…37 Troponin is included in a 6-parameter panel-including 4 brain injury-related proteins, 1 cardiac marker, and a clinical score-used to predict 6-month outcome. 38 The present study demonstrates an association between cTn elevation and poor outcome after SAH.…”

Section: Discussionmentioning

confidence: 87%

Cardiac Troponin Elevation and Outcome after Subarachnoid Hemorrhage: A Systematic Review and Meta-analysis

Zhang

Wang

2015

Journal of Stroke and Cerebrovascular Diseases

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Section: Discussionmentioning

confidence: 87%

Cardiac Troponin Elevation and Outcome after Subarachnoid Hemorrhage: A Systematic Review and Meta-analysis

Zhang

Wang

2015

Journal of Stroke and Cerebrovascular Diseases

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“…Depending on the location and the size of the aneurysm, the aneurysm was not treated, was treated by surgical clipping, or was treated by endovascular coil embolization. More details on the clinical monitoring and treatment have been previously described by Turck et al 36 Among 198 consecutively hospitalized patients, 137 were excluded from the present study due to 1) presence of more than 1 hemorrhagic event, 2) admission to the hospital more than 48 hours after the onset of symptoms, 3) missing clinical information, or 4) insufficient sample volume to perform our assays. Sixty-one patients were then finally included in this study (Fig.…”

Section: Methods Patients and Sample Collectionmentioning

confidence: 99%

“…Increased concentrations of S100 calcium binding proteinb (S100b), C-reactive protein, adhesion and matrix molecules, and vasogenic and cardiac markers have been found in aSAH patients with poor outcomes, but the limited accuracy of most of these markers has hampered their use in clinical practice. 13,27,36,38 Neopterin, a catabolic product of GTP (guanosine-5-triphosphate) produced by human monocytes-macrophages upon stimulation with interferon-g, has been reported as an outcome and infection biomarker for several inflammatory diseases. 6,19,35 Moreover, Mathiesen et al showed that the CSF and plasma concentrations of neopterin were higher in patients suffering from aSAH than in controls.…”

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confidence: 99%

Neopterin plasma concentrations in patients with aneurysmal subarachnoid hemorrhage: correlation with infection and long-term outcome

Azurmendi

Degos

Tiberti

et al. 2016

JNS

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A neurysmAl subarachnoid hemorrhage (aSAH) is a subtype of stroke associated with high rates of mortality and morbidity. Fifteen percent of patients die before arriving at a hospital, and 25% of deaths occur within the first 24 hours. 34 Among the survivors, 30% will develop a long-term delayed neurological deficit that will affect their quality of life. 21,32The long-term outcome partially depends on early diagnosis and management.1,12 Therefore, if an aneurysm is detected by CT in a patient with aSAH, invasive treatment is indicated to prevent a second hemorrhage from the affected vessel, the most important cause of death in the first 24 hours following aSAH. 20,25 Large studies, such as the International Subarachnoid Aneurysm Trial (ISAT), have investigated whether neurosurgical clipping or endovascular coiling improve the long-term outcome. It has been abbreviatioNs aSAH = aneurysmal subarachnoid hemorrhage; AUC = area under the ROC curve; DCI = delayed cerebral ischemia; EVD = external ventricular drain; GCS = Glasgow Coma Scale; GOS = Glasgow Outcome Scale; NSE = neuron-specific enolase; ROC = receiver operating characteristic; ROS = reactive oxygen species; S100b = S100 calcium binding protein-b; WBC = white blood cell; WFNS = World Federation of Neurosurgical Societies. obJective Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high rates of mortality and morbidity. The main predictor for the poor outcome is the World Federation of Neurosurgical Societies (WFNS) scale. However, this scale does not take into account proinflammatory events, such as infection occurring after the aSAH, which could modify the long-term status of patients. The aim of this study was to evaluate neopterin as an inflammatory biomarker for outcome and infection prediction in aSAH patients. methods Plasma concentrations of neopterin were measured in 61 aSAH patients (22 male and 39 female; mean age [± SD] 52.8 ± 11.8 years) using a commercial ELISA kit. Samples were collected daily for 10 days. Outcome at 12 months was determined using the Glasgow Outcome Scale (GOS) and dichotomized as poor (GOS score 1, 2, or 3) or good (GOS score 4 or 5). Infection was determined by the presence of a positive bacterial culture. results Patients with poor outcome at 12 months had higher concentrations of neopterin than patients with good outcome. In the same way, patients who had an infection during the hospitalization had significantly higher concentrations of neopterin than patients without infection (p = 0.001). Moreover, neopterin concentrations were significantly (p < 0.008) elevated in infected patients 2 days before infection detection and antibiotic therapy. coNclusioNs Neopterin is an efficient outcome predictor after aSAH. Furthermore, it is able to differentiate between infected and uninfected patients as early as 2 days before clinical signs of infection, facilitating earlier antibiotic therapy and better management.

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“…7,8,11 These scales are considered predictors of risk of delayed cerebral ischemia, 8 but no consensus exists as to their independent association with clinical outcomes after SAH. 5,[18][19][20]24,31,42,44 It is presently uncertain whether these neuroimaging parameters add incremental value beyond the effect of other established prognostic factors in SAH. With advances in diagnostic and interventional neuroradiology, and increasing patient selection for endovascular coiling rather than surgical clipping, further queries could be raised regarding their value as outcome predictors in SAH.…”

mentioning

confidence: 99%

Neuroimaging characteristics of ruptured aneurysm as predictors of outcome after aneurysmal subarachnoid hemorrhage: pooled analyses of the SAHIT cohort

Jaja

Lingsma

Schweizer

et al. 2016

JNS

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N euroimagiNg characteristics at hospital admission play an important role in the accurate diagnosis of subarachnoid hemorrhage (SAH) from ruptured intracranial aneurysms.3 They help to identify the aneurysm causing bleeding and outline its anatomical configuration and that of adjoining structures to guide optimal choice of treatment modality for exclusion of the ruptured aneurysm from circulation. Neuroimaging parameters at hospital admission have been investigated for their value as predictors of outcome after SAH. Among these param- obJective Neuroimaging characteristics of ruptured aneurysms are important to guide treatment selection, and they have been studied for their value as outcome predictors following aneurysmal subarachnoid hemorrhage (SAH). Despite multiple studies, the prognostic value of aneurysm diameter, location, and extravasated SAH clot on computed tomography scan remains debatable. The authors aimed to more precisely ascertain the relation of these factors to outcome. methods The data sets of studies included in the Subarachnoid Hemorrhage International Trialists (SAHIT) repository were analyzed including data on ruptured aneurysm location and diameter (7 studies, n = 9125) and on subarachnoid clot graded on the Fisher scale (8 studies; n = 9452) for the relation to outcome on the Glasgow Outcome Scale (GOS) at 3 months. Prognostic strength was quantified by fitting proportional odds logistic regression models. Univariable odds ratios (ORs) were pooled across studies using random effects models. Multivariable analyses were adjusted for fixed effect of study, age, neurological status on admission, other neuroimaging factors, and treatment modality. The neuroimaging predictors were assessed for their added incremental predictive value measured as partial R 2 . results Spline plots indicated outcomes were worse at extremes of aneurysm size, i.e., less than 4 or greater than 9 mm. In between, aneurysm size had no effect on outcome (OR 1.03, 95% CI 0.98-1.09 for 9 mm vs 4 mm, i.e., 75th vs 25th percentile), except in those who were treated conservatively (OR 1.17, 95% CI 1.02-1.35). Compared with anterior cerebral artery aneurysms, posterior circulation aneurysms tended to result in slightly poorer outcome in patients who underwent endovascular coil embolization (OR 1.13, 95% CI 0.82-1.57) or surgical clipping (OR 1.32, 95% CI 1.10-1.57); the relation was statistically significant only in the latter. Fisher CT subarachnoid clot burden was related to outcome in a gradient manner. Each of the studied predictors accounted for less than 1% of the explained variance in outcome. coNclusioNs This study, which is based on the largest cohort of patients so far analyzed, has more precisely determined the prognostic value of the studied neuroimaging factors. Treatment choice has strong influence on the prognostic effect of aneurysm size and location. These findings should guide the development of reliable prognostic models and inform the design and analysis of future prospective studies, including clinical...

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A multiparameter panel method for outcome prediction following aneurysmal subarachnoid hemorrhage

Abstract: The use of this panel, including four brain injury-related proteins, one cardiac marker and a clinical score, could be a valuable tool to identify aSAH patients at risk of poor outcome.

Cited by 80 publications

References 42 publications

Cardiac Troponin Elevation and Outcome after Subarachnoid Hemorrhage: A Systematic Review and Meta-analysis

Cardiac Troponin Elevation and Outcome after Subarachnoid Hemorrhage: A Systematic Review and Meta-analysis

Neopterin plasma concentrations in patients with aneurysmal subarachnoid hemorrhage: correlation with infection and long-term outcome

Neuroimaging characteristics of ruptured aneurysm as predictors of outcome after aneurysmal subarachnoid hemorrhage: pooled analyses of the SAHIT cohort

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