Soluble ST2 Is Associated With New Epileptiform Abnormalities Following Nontraumatic Subarachnoid Hemorrhage

Background and Purpose- We evaluated the association between 2 types of predictors of delayed cerebral ischemia after nontraumatic subarachnoid hemorrhage, including biomarkers of the innate immune response and neurophysiologic changes on continuous electroencephalography. Methods- We studied subarachnoid hemorrhage patients that had at least 72 hours of continuous electroencephalography and blood samples collected within the first 5 days of symptom onset. We measured inflammatory biomarkers previously associated with delayed cerebral ischemia and functional outcome, including soluble ST2 (sST2), IL-6 (interleukin-6), and CRP (C-reactive protein). Serial plasma samples and cerebrospinal fluid sST2 levels were available in a subgroup of patients. Neurophysiologic changes were categorized into new or worsening epileptiform abnormalities (EAs) or new background deterioration. The association of biomarkers with neurophysiologic changes were evaluated using the Wilcoxon rank-sum test. Plasma and cerebrospinal fluid sST2 were further examined longitudinally using repeated measures mixed-effects models. Results- Forty-six patients met inclusion criteria. Seventeen (37%) patients developed new or worsening EAs, 21 (46%) developed new background deterioration, and 8 (17%) developed neither. Early (day, 0-5) plasma sST2 levels were higher among patients with new or worsening EAs (median 115 ng/mL [interquartile range, 73.8-197]) versus those without (74.7 ng/mL [interquartile range, 44.8-102]; P=0.024). Plasma sST2 levels were similar between patients with or without new background deterioration. Repeated measures mixed-effects modeling that adjusted for admission risk factors showed that the association with new or worsening EAs remained independent for both plasma sST2 (β=0.41 [95% CI, 0.09-0.73]; P=0.01) and cerebrospinal fluid sST2 (β=0.97 [95% CI, 0.14-1.8]; P=0.021). IL-6 and CRP were not associated with new background deterioration or with new or worsening EAs. Conclusions- In patients admitted with subarachnoid hemorrhage, sST2 level was associated with new or worsening EAs but not new background deterioration. This association may identify a link between a specific innate immune response pathway and continuous electroencephalography abnormalities in the pathogenesis of secondary brain injury after subarachnoid hemorrhage.

Medienart:

E-Artikel

Erscheinungsjahr:

2020

Erschienen:

2020

Enthalten in:

Zur Gesamtaufnahme - volume:51

Enthalten in:

Stroke - 51(2020), 4 vom: 02. Apr., Seite 1128-1134

Sprache:

Englisch

Beteiligte Personen:

Lissak, India A [VerfasserIn]
Zafar, Sahar F [VerfasserIn]
Westover, M Brandon [VerfasserIn]
Schleicher, Riana L [VerfasserIn]
Kim, Jennifer A [VerfasserIn]
Leslie-Mazwi, Thabele [VerfasserIn]
Stapleton, Christopher J [VerfasserIn]
Patel, Aman B [VerfasserIn]
Kimberly, W Taylor [VerfasserIn]
Rosenthal, Eric S [VerfasserIn]

Links:

Volltext

Themen:

Biomarkers
Electroencephalography
IL1RL1 protein, human
Interleukin-1 Receptor-Like 1 Protein
Ischemia
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Subarachnoid hemorrhage

Anmerkungen:

Date Completed 16.09.2020

Date Revised 19.09.2021

published: Print-Electronic

Citation Status MEDLINE

doi:

10.1161/STROKEAHA.119.028515

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

NLM307444880