ObjectiveAmyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease involving both upper and lower motor neurons. The motor phenotypes of ALS are highly clinically heterogeneous, and the underlying mechanisms are poorly understood.MethodsA comparative proteomic analysis was performed in the cerebrospinal fluid (CSF) of bulbar‐onset (BO) and spinal‐onset (SO) ALS patients and controls (n = 14). Five biomarker candidates were selected from a differentially regulated protein pool, and further validation was performed in a larger independent cohort (n = 92) using enzyme‐linked immunosorbent assay (ELISA).ResultsA total of 1732 CSF proteins were identified, and 78 differentially expressed proteins were found among BO‐ALS patients, SO‐ALS patients, and controls. Five promising biomarker candidates were selected for further validation, and lipopolysaccharide‐binding protein (LBP) and HLA class II histocompatibility antigen, DR alpha chain (HLA‐DRA) were validated. CSF LBP levels were increased in ALS patients compared with controls and higher in BO‐ALS versus SO‐ALS. The increased CSF LBP levels were correlated with the revised ALS Functional Scale (ALSFRS‐R) score. CSF HLA‐DRA levels were specifically elevated in BO‐ALS patients, and there was no significant difference between SO‐ALS patients and controls. Increased HLA‐DRA expression was correlated with decreased survival.InterpretationOur data shows that elevated CSF LBP is a good biomarker for ALS and correlates with clinical severity, and increased HLA‐DRA is a specific biomarker for BO‐ALS and may predict short survival. It also suggests that the microglial pathway and HLA‐II‐related adaptive immunity may be differentially involved in ALS phenotypes and may be new therapeutic targets for ALS.

Objective: Status epilepticus (SE) is a common neurological emergency with unsatisfying prognoses, and accurate prediction of functional outcome is beneficial in clinical decision-making. The relationship between serum albumin concentration and outcome of SE patients has yet to be unveiled. Methods: Clinical profiles of SE patients admitted to Xiangya Hospital, CentralSouth University, from April 2017 to November 2020, were analyzed retrospectively. Outcomes of SE patients at discharge were divided into two groups based on the modified Rankin Scale (mRS): favorable outcome (mRS: 0-3) and unfavorable outcome (mRS: 4-6).Results: Fifty-one patients were enrolled. Unfavorable functional outcome at discharge was reported in 60.8% (31/51). Serum albumin concentration at admission and the Encephalitis-NCSE-Diazepam resistance-Image abnormalities-Tracheal intubation (END-IT) score remained independent predictors for functional outcome of SE patients. A lower albumin concentration at admission and higher END-IT score indicated a higher chance of unfavorable outcome for SE patients.The cut-off value of serum albumin to predict unfavorable outcome was 35.2 g/L, with a sensitivity of 67.7% and specificity of 85.0%, and an area under the receiver operating characteristic curve (ROC) of .738 (95% CI: .600-.876, p = .004). The preferable END-IT score with optimal sensitivity (74.2%) and specificity (60%) was 2 and the area under the ROC was .742, with 95% CI of .608-.876 (p = .004).Significance: Serum albumin concentration at admission and the END-IT score are two independent predictive factors for short-term outcome of SE patients, moreover, the serum albumin concentration is not inferior to the END-IT score in indicating functional outcome at discharge.