Additive prognostic impact of the cerebrospinal fluid arginine/ornithine ratio to established clinical scores in aneurysmal subarachnoid hemorrhage

Abstract

Cerebrospinal fluid (CSF) metabolites are increasingly recognized as prognostic factors in aneurysmal subarachnoid hemorrhage (SAH). The CSF arginine/ornithine ratio (Arg/Orn) was shown to predict cerebral vasospasms and clinical outcome in SAH. The additive prognostic value of Arg/Orn over established prognostic scores has not been investigated. CSF Arg/Orn and the established prognostic scores SAH, FRESH, SAH-PDS, HAIR, Rosen–McDonald, Hunt and Hess, WFNS and modified Fisher scale were determined in a prospective cohort of patients with aneurysmal SAH. Logistic regression models to predict a favorable outcome, defined as a modified Rankin Scale score of 0–3 at 3 months follow-up, were constructed for each score, both with and without the addition of Arg/Orn. The impact of Arg/Orn was assessed comparing logistic regression models containing the respective score with and without Arg/Orn with the likelihood ratio chi-squared test. CSF Arg/Orn and clinical scores were determined in 38 SAH patients. Arg/Orn was an independent predictor of clinical outcome when added to established prognostic scores (p < 0.05) with the exception of HAIR (p = 0.078). All models were significantly improved if Arg/Orn was added as a covariable (p < 0.05). The results of this study confirm Arg/Orn as an independent prognostic factor and its addition improves established prognostic models in SAH.

Navigating through the paradox of choice: prediction of outcome in aneurysmal subarachnoid hemorrhage

“…A number of biomarkers including enolase, S100B, and GFAP (glial fibrillary acidic protein) in blood and cerebrospinal fluid (CSF) have been evaluated for their accuracy in predicting mortality [ 16 ]. In addition to the previously used ones, dynamic changes in total tau in the cerebral microdialysate [ 17 ] and the CSF arginine/ornithine ratio are among the latest areas of interest [ 18 ]. An interesting online, visual dynamic nomogram has been proposed to predict the risk of adverse outcome at 6 months in elderly patients after undergoing endovascular therapy for aneurysmal SAH [ 19 ].…”