Is Admission Lipoprotein-Associated Phospholipase A2 a Novel Predictor of Vasospasm and Outcome in Patients With Aneurysmal Subarachnoid Hemorrhage?

Abstract

BACKGROUND The relationships between lipoprotein-associated phospholipase A2 (Lp-PLA2) level, vasospasm, and clinical outcome of patients with aneurysmal subarachnoid hemorrhage (aSAH) are still unclear. OBJECTIVE To identify the associations between admission Lp-PLA2 and vasospasm following subarachnoid hemorrhage and the clinical outcome of aSAH. METHODS A total of 103 aSAH patients who had Lp-PLA2 level obtained within 24 h postbleeding were included. The relationships between Lp-PLA2 level, vasospasm, and clinical outcome were analyzed. RESULTS Vasospasm was observed in 52 patients (50.49%). Patients with vasospasm had significantly higher Lp-PLA2 level than those without (P < .001). Both modified Fisher grade (P = .014) and Lp-PLA2 level (P < .001) were significant predictors associated with vasospasm. The Z test revealed that power of Lp-PLA2 was significantly higher than that of modified Fisher grade in predicting vasospasm (Z = 2.499, P = .012). At 6-mo follow-up, 44 patients (42.72%) had unfavorable outcome and 36 patients (34.95%) died. The World Federation of Neurosurgical Societies (WFNS) grade and Lp-PLA2 level were both significant predictors associated with 6-mo unfavorable outcome and mortality (all P < .001). The predictive values of Lp-PLA2 for unfavorable outcome and mortality at 6-mo tended to be lower than those of the WFNS grade, but the differences were not statistically significant (P = .366 and 0.115, respectively). Poor-grade patients having Lp-PLA2 > 200 μg/L had significantly worse 6-mo survival rate than poor-grade patients having Lp-PLA2 ≤ 200 μg/L (P = .001). CONCLUSION The Lp-PLA2 might be useful as a novel predictor in aSAH patients. A total of 30 poor-grade patients; those with elevated Lp-PLA2 level have higher risk of 6-mo mortality compared to those without.

The Use of Acute Normovolemic Hemodilution in Clipping Surgery for Aneurysmal Subarachnoid Hemorrhage

“…The average number of patients with aSAH who were admitted to our hospital per month during the COVID-19 pandemic was not significantly different from that in the previous report (17 patients/month vs. 17.9 patients/month). 17 No patient with posterior circulation aneurysm underwent clipping in this cohort. A pterional keyhole approach was used except in 3 patients who developed brain herniation and received classic decompressive hemicraniectomy (1 [5%] vs. 2 [4.8%]; P = 0.967).…”

“…The rate and spectrum of postoperative complications in both the ANH group and the non-ANH group were consistent with a previous report from our institution. 17 …”

“…Data were retrieved from a quality control database in which data of patients with aSAH were prospectively entered and saved as the previous report in our hospital. 17 Written informed consent was obtained from all patients or their relatives if the patient could not sign the form by themselves. This study was approved by the ethics committee of our hospital.…”

Can admission lipoprotein-associated phospholipase A2 predict the symptomatic cerebral vasospasm following aneurysmal subarachnoid hemorrhage?

“…Therefore, if early prognosis of CV could be achieved to predict potential risks, optimized care and more effective distribution of healthcare resources might be made possible for these patients. There have been studies reporting on the connection between elevated Lp-PLA2 level and ACV in aSAH patients [19]. The associated morbidity and mortality of SCV could be higher than ACV.…”

“…Lipoproteinassociated phospholipase A2 (Lp-PLA2) is an available potential biomarker of inflammation in blood vessels [15][16][17][18]. It has been reported that in aSAH patients, elevated Lp-PLA2 level is related to angiographic cerebral vasospasm (ACV) [19]. However, whether Lp-PLA2 can predict the occurrence of symptomatic cerebral vasospasm (SCV) in aSAH patients is still unknown.…”