Clinical Value of Serum Secretoneurin Levels in Prediction of Delayed Cerebral Ischemia and Prognostic Analysis of Aneurysmal Subarachnoid Hemorrhage: A Prospective Cohort Study

Jiasen Ma,1 Xiuqin Huang,2 Yanping Hu,1 Bing Xu,1 Chunhua Jin1 1Emergency Department, Shaoxing People’s Hospital, Shaoxing, Zhejiang Province, People’s Republic of China; 2Department of Plastic and Cosmetic Surgery, The 72nd Group Military Hospital of the People’s Liberation Army of China, Huzhou, Zhejiang Province, People’s Republic of ChinaCorrespondence: Chunhua Jin, Emergency Department, Shaoxing People’s Hospital, Shaoxing, Zhejiang Province, People’s Republic of China, Email mjsjch@163.comBackground: Secretoneurin is a neuropeptide with several neuroprotective properties. Here, we discuss the importance of serum secretoneurin in assessing severity and predicting delayed cerebral ischemia (DCI) and functional outcomes following aneurysmal subarachnoid hemorrhage (aSAH).Methods: A prospective cohort study of 167 patients with aSAH and 100 controls was performed to determine serum secretoneurin levels. Severity was reflected by the Hunt-Hess and modified Fisher scores. Prognostic parameters included DCI and poor 6-month prognosis (extended Glasgow outcome scale scores of 1– 4). Univariate analysis followed by multivariate analysis was performed to determine the correlation between severity and prognosis.Results: Compared to controls, patients exhibited a marked elevation in serum secretoneurin levels. Serum secretoneurin levels, which were independently correlated with Hunt-Hess scores and modified Fisher scores, independently predicted DCI and bad 6-month prognosis. Serum secretoneurin levels, which were linearly related to the risk of DCI and poor prognosis under a restricted cubic spline, effectively distinguished the risks under the receiver operating characteristic (ROC) curve. Subgroup analysis for prognosis or DCI prediction revealed no substantial interactions between serum secretoneurin levels and other variables, such as age, sex, hypertension, diabetes, alcohol consumption, and cigarette consumption. In addition, the prognosis model, in which serum secretoneurin, Hunt-Hess scale, and modified Fisher scale were merged, was graphically represented by a nomogram and performed well under the calibration, decision, and ROC curves.Conclusion: Serum secretoneurin levels significantly increased after aSAH, which was intimately correlated with disease severity and independently associated with DCI and worse outcomes, indicating that serum secretoneurin may be a potential prognostic biomarker of aSAH.Keywords: aneurysm, subarachnoid hemorrhage, secretoneurin, delayed cerebral ischemia, prognosis, outcome, severity