Clin Chem Lab Med 2015; 53(8): e179–e181
Letter to the Editor Zaida Ruiz de Azúa López*, Juan José Egea-Guerrero, Gloria Rivera-Rubiales, Ana Rodríguez-Rodríguez, Ángel Vilches-Arenas and Francisco Murillo-Cabezas
Serum brain injury biomarkers as predictors of mortality after severe aneurysmal subarachnoid hemorrhage: preliminary results DOI 10.1515/cclm-2014-1189 Received December 2, 2014; accepted January 26, 2015; previously published online March 10, 2015
Keywords: aneurysmal subarachnoid hemorrhage; mortality; neuron-specific enolase; outcome; S100B protein. To the Editor, Roughly 80% of non-traumatic blood extravasation into the subarachnoid space results from aneurysmal subarachnoid hemorrhage (aSAH), a condition with an estimated incidence rate of 4–28 per 100,000 inhabitants [1]. Although diagnostic and therapeutic advances over the last two decades have decreased morbidity and mortality after aSAH, it is estimated that 24%–50% of patients die and up to 40% of survivors present disabling sequelae [2, 3]. aSAH outcome has been shown to correlate with neurological status at admission [Hunt and Hess (HH) classification and the World Federation of Neurological Surgeons scale (WFNS)], blood level in the initial computerized tomographic (CT) scan (Modified Fisher grade), and the development of secondary complications [4]. However, we still lack brain injury biomarkers that allow us to objectively assess the severity of aSAH and determine the prognosis of these patients. Several biomarkers have been proposed for cerebral event identification in clinical *Corresponding author: Zaida Ruiz de Azúa López, Virgen del Rocío University Hospital – Neurocritical Care Unit, Calle Marco Sancho número 26, Seville, Andalucia 41002, Spain, Phone: 340675669800, E-mail: [email protected]; [email protected] Juan José Egea-Guerrero, Gloria Rivera-Rubiales and Francisco Murillo-Cabezas: Virgen del Rocío University Hospital – Neurocritical Care Unit, Seville, Andalucia, Spain Ana Rodríguez-Rodríguez: University of Sevilla – IBIS/CSIC, Seville, Andalucia, Spain Ángel Vilches-Arenas: University of Seville – Department Preventive Medicine and Public Health, Seville, Andalucia, Spain
practice, with neuron-specific enolase (NSE) and S100B level being the most widely investigated [5]. The aim of this preliminary study is to evaluate the prognostic value of S100B and NSE serum peak levels in patients with severe aSAH. We performed a prospective, observational study of all patients admitted to the Neurosurgical Intensive Care Unit (ICU) at the Virgen del Rocio University Hospital in Seville, Spain during a 24-month long period. A total of 67 patients were admitted to the ICU with an aSAH diagnosis. The final analysis included 46 patients, whose main characteristics are summarized in Table 1. This study was approved by our hospital Ethics Committee. Written informed consent was obtained from patients’ family members. Inclusion criteria included the following: clinical history of SAH with evidence of bleeding on CT scan, admission to the ICU within 24 hours of onset, aged 18 or over and absence of tumor, trauma, previous episodes of SAH or any other neurological disease that could modify the results. The following parameters were recorded: age, gender, past medical history (hypertension, smoking), aneurysm location, HH, WFNS, Modified Fisher grade, presence of acute hydrocephalus or vasospasm, diagnostic arteriography, type of treatment (surgery or coiling), length of stay in ICU and mortality. Venous blood samples were collected daily from Day 0 (initial bleeding) until Day 15. Samples were centrifuged at 1800 g for 10 min, and determinations of S100B and NSE levels were performed using a commercially available test (ECLIA) produced by Elecsys 2010 Immunoassay Systems (Roche Diagnostic, Germany). We analyzed peak S100B and NSE values of each patient during the study period. Data were presented as means [standard deviation (SD)], medians [interquartile range (IQR)], frequencies (n) and percentages. Student’s t-test or the non-parametric Mann Whitney U-test verified between-group differences. Bivariate and multivariate analyses were also performed. Statistical significance was defined as p
Letter to the Editor Zaida Ruiz de Azúa López*, Juan José Egea-Guerrero, Gloria Rivera-Rubiales, Ana Rodríguez-Rodríguez, Ángel Vilches-Arenas and Francisco Murillo-Cabezas
Serum brain injury biomarkers as predictors of mortality after severe aneurysmal subarachnoid hemorrhage: preliminary results DOI 10.1515/cclm-2014-1189 Received December 2, 2014; accepted January 26, 2015; previously published online March 10, 2015
Keywords: aneurysmal subarachnoid hemorrhage; mortality; neuron-specific enolase; outcome; S100B protein. To the Editor, Roughly 80% of non-traumatic blood extravasation into the subarachnoid space results from aneurysmal subarachnoid hemorrhage (aSAH), a condition with an estimated incidence rate of 4–28 per 100,000 inhabitants [1]. Although diagnostic and therapeutic advances over the last two decades have decreased morbidity and mortality after aSAH, it is estimated that 24%–50% of patients die and up to 40% of survivors present disabling sequelae [2, 3]. aSAH outcome has been shown to correlate with neurological status at admission [Hunt and Hess (HH) classification and the World Federation of Neurological Surgeons scale (WFNS)], blood level in the initial computerized tomographic (CT) scan (Modified Fisher grade), and the development of secondary complications [4]. However, we still lack brain injury biomarkers that allow us to objectively assess the severity of aSAH and determine the prognosis of these patients. Several biomarkers have been proposed for cerebral event identification in clinical *Corresponding author: Zaida Ruiz de Azúa López, Virgen del Rocío University Hospital – Neurocritical Care Unit, Calle Marco Sancho número 26, Seville, Andalucia 41002, Spain, Phone: 340675669800, E-mail: [email protected]; [email protected] Juan José Egea-Guerrero, Gloria Rivera-Rubiales and Francisco Murillo-Cabezas: Virgen del Rocío University Hospital – Neurocritical Care Unit, Seville, Andalucia, Spain Ana Rodríguez-Rodríguez: University of Sevilla – IBIS/CSIC, Seville, Andalucia, Spain Ángel Vilches-Arenas: University of Seville – Department Preventive Medicine and Public Health, Seville, Andalucia, Spain
practice, with neuron-specific enolase (NSE) and S100B level being the most widely investigated [5]. The aim of this preliminary study is to evaluate the prognostic value of S100B and NSE serum peak levels in patients with severe aSAH. We performed a prospective, observational study of all patients admitted to the Neurosurgical Intensive Care Unit (ICU) at the Virgen del Rocio University Hospital in Seville, Spain during a 24-month long period. A total of 67 patients were admitted to the ICU with an aSAH diagnosis. The final analysis included 46 patients, whose main characteristics are summarized in Table 1. This study was approved by our hospital Ethics Committee. Written informed consent was obtained from patients’ family members. Inclusion criteria included the following: clinical history of SAH with evidence of bleeding on CT scan, admission to the ICU within 24 hours of onset, aged 18 or over and absence of tumor, trauma, previous episodes of SAH or any other neurological disease that could modify the results. The following parameters were recorded: age, gender, past medical history (hypertension, smoking), aneurysm location, HH, WFNS, Modified Fisher grade, presence of acute hydrocephalus or vasospasm, diagnostic arteriography, type of treatment (surgery or coiling), length of stay in ICU and mortality. Venous blood samples were collected daily from Day 0 (initial bleeding) until Day 15. Samples were centrifuged at 1800 g for 10 min, and determinations of S100B and NSE levels were performed using a commercially available test (ECLIA) produced by Elecsys 2010 Immunoassay Systems (Roche Diagnostic, Germany). We analyzed peak S100B and NSE values of each patient during the study period. Data were presented as means [standard deviation (SD)], medians [interquartile range (IQR)], frequencies (n) and percentages. Student’s t-test or the non-parametric Mann Whitney U-test verified between-group differences. Bivariate and multivariate analyses were also performed. Statistical significance was defined as p
