Plasma Soluble Urokinase-Type Plasminogen Activator Receptor Is Not Associated with Neurological Outcome in Patients with Aneurysmal Subarachnoid Hemorrhage

Abstract

ObjectAneurysmal subarachnoid hemorrhage (aSAH) is a common cause of death or long-term disability. Despite advances in neurocritical care, there is still only a very limited ability to monitor the development of secondary brain injury or to predict neurological outcome after aSAH. Soluble urokinase-type plasminogen activator receptor (suPAR) has shown potential as a prognostic and as an inflammatory biomarker in a wide range of critical illnesses since it displays an association with overall immune system activation. This is the first time that suPAR has been evaluated as a prognostic biomarker in aSAH.MethodsIn this prospective population-based study, plasma suPAR levels were measured in aSAH patients (n = 47) for up to 5 days. suPAR was measured at 0, 12, and 24 h after patient admission to the intensive care unit (ICU) and daily thereafter until he/she was transferred from the ICU. The patients’ neurological outcome was evaluated with the modified Rankin Scale (mRS) at 6 months after aSAH.ResultssuPAR levels (n = 47) during the first 24 h after aSAH were comparable in groups with a favorable (mRS 0–2) or an unfavorable (mRS 3–6) outcome. suPAR levels during the first 24 h were not associated with the findings in the primary brain CT, with acute hydrocephalus, or with antimicrobial medication use during 5-days’ follow-up. suPAR levels were associated with generally accepted inflammatory biomarkers (C-reactive protein, leukocyte count).ConclusionPlasma suPAR level was not associated with either neurological outcome or selected clinical conditions. While suPAR is a promising biomarker for prognostication in several conditions requiring intensive care, it did not reveal any value as a prognostic biomarker after aSAH.

S100B, NSE and MMP-9 fail to predict neurologic outcome while elevated S100B associates with milder initial clinical presentation after aneurysmal subarachnoid hemorrhage

“…There is a dire need for a clinically reliable biomarker, which could be used for better prediction of prognosis and/or as a surrogate for developing complications after aSAH. Despite extensive research on the topic, a reliable biomarker is still lacking [10][11][12][13][14].…”

Temporal patterns of inflammatory biomarkers measured in the cerebrospinal fluid of patients with aneurysmal subarachnoid hemorrhage using multiplex Proximity Extension Assay technology.

“…Plasma concentrations of its receptor (soluble uPA-receptor) was not shown to correlate with neurological outcome post SAH. [40] General considerations…”

Admission Lower Serum Phosphate Ion Levels Predict Acute Hydrocephalus of Aneurysmal Subarachnoid Hemorrhage

“…Numerous factors, including female sex, elderly age, higher mFisher grade, intraventricular hemorrhage, and laboratory findings, have been reported in prior literature to predict the occurrence of aHCP following aSAH (1,7,8,10,11). In recent years, considerable efforts have been focused on studying sensitive biomarkers for predicting aHCP (12)(13)(14), but reports of these biomarkers on the risk factors for aHCP development are inconsistent and controversial (13)(14)(15)(16). Clinically, laboratory biomarkers have received extensive attention and research due to their convenience, practicality, and sensitivity (17).…”