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Early matrix metalloproteinase-9 concentration in the first 48 h after aneurysmal subarachnoid haemorrhage predicts delayed cerebral ischaemia: An observational study
- Source :
- European Journal of Anaesthesiology, European Journal of Anaesthesiology, Lippincott, Williams & Wilkins, 2016, 33 (9), pp.662--669. ⟨10.1097/EJA.0000000000000494⟩, European Journal of Anaesthesiology, 2016, 33 (9), pp.662--669. ⟨10.1097/EJA.0000000000000494⟩
- Publication Year :
- 2016
- Publisher :
- HAL CCSD, 2016.
-
Abstract
- International audience; BACKGROUND: Delayed cerebral ischaemia from vasospasm is an important cause of complications and death after aneurysmal subarachnoid haemorrhage. There is currently no established biomarker for identifying patients at high risk of delayed cerebral ischaemia.ăOBJECTIVE: Considering the important role of inflammation in the pathogenesis of delayed cerebral ischaemia, we investigated whether matrix metalloproteinase-9 (MMP-9) may be an efficient biomarker for predicting elayed cerebral ischaemia after subarachnoid haemorrhage.ăDESIGN: Single-centre prospective observational study.ăSETTING: Neuroscience Critical Care Unit of a teaching hospital.ăPARTICIPANTS: Thirty consecutive patients with severe subarachnoid haemorrhage requiring external ventricular drainage were enrolled during 2013 and 2014.ăINTERVENTIONS: Blood and cerebrospinal fluid (CSF) were sampled within the first 24 h and between 48 and 72 h after admission. We evaluated the activity and concentrations of MMP-9 and endothelin-1 with zymography and ELISA. Patients were allocated to groups with delayed cerebral ischaemia (n = 16) or without delayed cerebral ischaemia (n = 14).ăRESULTS: Within 24 h, median [interquartile range] MMP-9 concentrations in CSF were significantly higher in patients with delayed cerebral ischaemia (47 [21 to 102] ng ml) than in those without delayed cerebral ischaemia (4 [2 to 13] ng ml, P = 0.001). CSF MMP-9 activity and endothelin-1 concentrations were correlated (r = 0.6, P = 0.02). The areas under the receiver operating characteristic curves were 0.73 (95% confidence interval [0.53 to 0.87]) and 0.91 (95% confidence interval [0.75 to 0.98]) for MMP-9 concentrations in plasma and CSF, respectively, at 24 h to predict delayed cerebral ischaemia CSF MMP-9 concentrations more than 14.3 ng ml at 24 h predicted the occurrence of delayed cerebral ischaemia with a sensitivity and specificity of 88 and 86%, respectively. After multivariate logistic analysis, only CSF MMP-9 concentrations at 24 h predicted the occurrence of delayed cerebral ischaemia (P = 0.01).ăCONCLUSION: MMP-9 concentrations in both plasma and CSF, measured within 48 h after subarachnoid haemorrhage, were highly predictive of the occurrence of delayed cerebral ischaemia within the first 2 weeks.ăTRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT02397759.
- Subjects :
- Adult
Male
Time Factors
Subarachnoid hemorrhage
[SDV.NEU.NB]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC]/Neurobiology
Pilot Projects
030204 cardiovascular system & hematology
Brain Ischemia
Brain ischemia
03 medical and health sciences
0302 clinical medicine
Cerebrospinal fluid
Predictive Value of Tests
Interquartile range
medicine
Humans
Prospective Studies
cardiovascular diseases
Prospective cohort study
Aged
business.industry
Vasospasm
Middle Aged
Subarachnoid Hemorrhage
medicine.disease
3. Good health
Anesthesiology and Pain Medicine
Matrix Metalloproteinase 9
Predictive value of tests
Anesthesia
Biomarker (medicine)
Female
business
Biomarkers
030217 neurology & neurosurgery
Subjects
Details
- Language :
- English
- ISSN :
- 02650215 and 13652346
- Database :
- OpenAIRE
- Journal :
- European Journal of Anaesthesiology, European Journal of Anaesthesiology, Lippincott, Williams & Wilkins, 2016, 33 (9), pp.662--669. ⟨10.1097/EJA.0000000000000494⟩, European Journal of Anaesthesiology, 2016, 33 (9), pp.662--669. ⟨10.1097/EJA.0000000000000494⟩
- Accession number :
- edsair.doi.dedup.....6b908e2516026327b7763236de379e38