Plasma Amino Acids May Improve Prediction Accuracy of Cerebral Vasospasm after Aneurysmal Subarachnoid Haemorrhage

Abstract

Aneurysmal subarachnoid haemorrhages (aSAH) account for 5% of strokes and continues to place a great burden on patients and their families. Cerebral vasospasm (CVS) is one of the main causes of death after aSAH, and is usually diagnosed between day 3 and 14 after bleeding. Its pathogenesis remains poorly understood. To verify whether plasma concentration of amino acids have prognostic value in predicting CVS, we analysed data from 35 patients after aSAH (median age 55 years, IQR 39–62; 20 females, 57.1%), and 37 healthy volunteers (median age 50 years, IQR 38–56; 19 females, 51.4%). Fasting peripheral blood samples were collected on postoperative day one and seven. High performance liquid chromatography-mass spectrometry (HPLC-MS) analysis was performed. The results showed that plasma from patients after aSAH featured a distinctive amino acids concentration which was presented in both principal component analysis and direct comparison. No significant differences were noted between postoperative day one and seven. A total of 18 patients from the study group (51.4%) developed CVS. Hydroxyproline (AUC = 0.7042, 95%CI 0.5259–0.8826, p = 0.0248) and phenylalanine (AUC = 0.6944, 95%CI 0.5119–0.877, p = 0.0368) presented significant CVS prediction potential. Combining the Hunt-Hess Scale and plasma levels of hydroxyproline and phenylalanine provided the model with the best predictive performance and the lowest leave-one-out cross-validation of performance error. Our results suggest that plasma amino acids may improve sensitivity and specificity of Hunt-Hess scale in predicting CVS.

The Difference in Serum Metabolomic Profiles between the Good and Poor Outcome Groups at 3 Months in the Early and Late Phases of Aneurysmal Subarachnoid Hemorrhage

“…In a study involving 29 patients, amino acid levels were higher in the poor outcome group compared to the favorable outcome group, but the significance of the difference was very slight and was only observed in the early stage (0–3 days) [ 40 ]. In another study where plasma samples of aSAH patients were examined [ 41 ], no differences were found in the levels of amino acids between early and late samples, nor between the plasma amino acid levels of good and poor outcome groups; in fact, certain amino acid levels decreased in the plasma of aSAH patients compared to controls. Tuoho et al observed a hypermetabolic state in patients with ICH and aSAH undergoing surgery [ 42 ]; similar results were observed in another study [ 43 ], additionally demonstrating that increased amino acid infusion had no effect on amino acid exchange.…”

Prognostic Biomarkers for Delayed Cerebral Ischemia Post-Aneurysmal Subarachnoid Hemorrhage: Evaluating CSF 8-iso-Prostaglandin F2α and Erythrocyte Anisocytosis

“…RDW can be expressed as a standard deviation (RDW-SD) or as a coe cient of variation (RDW-CV) [22]. Analysis conducted in 2022, showed that SAH patients with poor outcome, had had signi cantly greater RDW-CV on admission (13.9% vs 12.8%, p = 0.016) [23].…”

Prognostic model for aneurysmal subarachnoid hemorrhage patients requiring mechanical ventilation

“…According to some clinicians, aSAH patients requiring prolonged mechanical ventilation have a poor prognosis 14 . Therefore, it is important to identify early prognostic predictors for patients with aSAH, as part of their management 15 . However, the long‐term clinical outcomes of aSAH patients requiring mechanical ventilation remain unpredictable, and no prognostic model has been developed.…”