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

Abstract

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.

Infection prediction for aneurysmal subarachnoid hemorrhage patients at hospital admission: combined panel of serum amyloid A and clinical parameters

“…In a previous study, we showed also that NP correlates with the progression of infection from three days after hospitalization [14]. Nevertheless, present results showed that this discrimination capacity was not effective at the admission to the hospital, making from SAA an earlier and most accurate infection marker than NP.…”

“…However, for aSAH patients, no blood biomarkers are available in clinical practice. We recently showed that neopterin (NP) and serum amyloid A (SAA) could be promising predictive markers of infection as their plasma concentrations were significantly higher in patients developing infection during hospitalization compared to those who did not [12][13][14].…”

Curative effect of surgery combined with nerve growth factor preparation treatment of acute cerebral hemorrhage

“…In the primary and secondary damage process of neural function, neurons and glial cells within the nervous tissue will rupture and cause the release of many marker molecules from the cytoplasm into outside of the cells, which cross through the damaged blood brain barrier and enter into the blood circulation [15][16]. S100β and NSE are the marker molecules positioning in neurons, the former is a kind of calcium-binding protein, and it is closely related to the regulation of Ca2+ homeostasis within neurons and the regulation of cytoskeleton elements; the latter is the key enzyme of glycolysis function way in neurons, and it is of great significance to the neuron ATP production and function [17].…”

Curative effect of minimally invasive puncture and drainage assisted with alteplase on treatment of acute intracerebral hemorrhage

“…The damage of blood brain barrier will lead to the release of OPN into blood circulation [18]. S100β and NSE are mainly expressed in the neuron cells, while the former one participates in the regulation of intracellular calcium homeostasis and the dynamic change of cytoskeletal components, and the latter one gets involve with the regulation of energy metabolism in the cell [19][20][21]. GFAP and MBP are mainly expressed in the neurogliocyte which participates in the formation of cytoskeleton and the regulation and control of cell membrane stability [22,23].…”