Expression And Significance Of Cerebrospinal Fluid Advanced Oxidation Protein Products Levels In Aneurysmal Subarachnoid Hemorrhage

Objective:Aneurysmal subarachnoid hemorrhage(aSAH)is a relatively common hemorrhagic cerebrovascular disease that often places a heavy burden on patients and families due to the intensity of the initial blood discharge and the development of secondary brain injury.The mechanisms of secondary brain injury after a SAH are complicated,in which neuroinflammation and oxidative stress injury occupy an important role.Appropriate biomarkers can not only accurately assess the patients’ condition and prognosis,help physicians monitor the patients’ condition and achieve graded management in a timely manner,but also lay the foundation for further exploration of the mechanisms involved in secondary brain injury,to effectively enhance the patients’ prognosis.Advanced oxidation protein products(AOPPs)are stable proteins injured by oxidative stress and inflammation.In this study,we intended to examine the expression of AOPPs in the cerebrospinal fluid(CSF)of patients with a SAH,and to understand their affiliations with the severity of disease and prognosis of patients with a SAH,to lay the foundation for further studies.Methods:According to the inclusion and exclusion criteria,we collected information and CSF samples from 50 patients with a SAH treated by interventional embolization of intracranial aneurysms at the Yuncheng Central Hospital in Shanxi Province.CSF samples were collected sequentially by lumbar puncture or lumbar drainage from 1-3 d,4-6 d,7-9 d and10-12 d after the hemorrhage during the hospitalization of a SAH patients.The levels of CSF AOPPs of each group and the levels of CSF interleukin(IL)-6 on days 1-3 after the hemorrhage of a SAH were measured by ELISA.The World Federation of Neurological Surgeons(WFNS)grading,modified Fisher grading and Hunt-Hess grading were used to assess the severity of disease at admission in patients with a SAH(one of the grading ≥ III was considered as severe a SAH),meanwhile,CSF IL-6 levels and peripheral blood white blood cell(WBC)count were used to assess the degree of inflammatory injury.The prognosis of patients at 90-day after bleeding were assessed using the modified Rankin Scale(m RS)scores,which greater than 2 were considered poor prognosis.The correlation between CSF AOPPs levels and the severity of disease in a SAH patients was analyzed by analyzing the correlation between CSF AOPPs levels on days 1-3 after hemorrhage and WFNS grading,modified Fisher grading,Hunt-Hess grading,CSF IL-6 level and WBC count.Univariate and multifactor logistic regression analysis models were constructed to analyze the predictors of poor prognosis in a SAH patients,and the receiver operating characteristic(ROC)curves were further constructed to calculate the area under the curve(AUC)of CSF AOPPs levels in each group.Finally,we also determined the optimal cut-off point of CSF AOPPs levels to assess the prognostic value.Results:(1)Among the 50 patients with aSAH,21 patients(42.0%)were considered to have poor prognosis according to the m RS scores.The levels of CSF AOPPs in patients with a SAH with poor prognosis were significantly higher than those with good prognosis in all time periods(P<0.05).The CSF AOPPs levels of patients with a SAH peaked on days 1-3 after hemorrhage,and then gradually decreased.(2)The CSF AOPPs levels on days 1-3 after hemorrhage in patients with a SAH were correlated with WFNS grading,modified Fisher grading,Hunt-Hess grading,CSF IL-6 levels,and WBC count(P<0.05).(3)By constructing one-way logistic regression model,patients’ age,WFNS grading,modified Fisher grading,Hunt-Hess grading,CSF IL-6 levels on days 1-3,WBC count,and CSF AOPPs levels on days 1-3,4-6,7-9 and 10-12 were correlated with poor prognosis(P<0.05),multi-factor logistic regression analysis was further constructed after inclusion of confounding factors,showing that the CSF AOPPs levels on days 1-3,4-6 and 7-9 after hemorrhage were associated with poor prognosis(P<0.05).(4)By constructing the ROC prognostic curves,we obtained the optimal cut-off points for the levels of CSF AOPPs in different time groups,while the levels of CSF AOPPs on days 1-3 after hemorrhage had the best AUC value.Conclusion:CSF AOPPs levels are significantly elevated in patients with a SAH with poor prognosis and peaked at an early stage.It may be a potential biomarker for assessing the severity of neurological injury and prognosis in patients with aSAH.