Biomarkers of Endothelial Activation in Delayed Cerebral Ischaemia after aneurysmal Subarachnoid Haemorrhage: A Prospective Cohort Study

Background: 

Endothelial cell activation seems to be an important process in the multifactorial pathophysiology of delayed cerebral ischemia (DCI) and subsequent poor clinical outcome after aneurysmal subarachnoid haemorrhage (aSAH). Aim: To assess the association between biomarker levels of endothelial activation and the occurrence of DCI and poor clinical outcome six months after aSAH. 

Methods: 

Between October 2018 and November 2020, 75 aSAH patients were included. Blood samples were taken on admission, day 3-5 and day 9-11 after aSAH. Ten patients with unruptured intracranial aneurysms served as controls. Poor outcome was assessed at six months, defined by a modified Rankin Scale score of 4 to 6. The cohort was dichotomized into patients with and without DCI and good and poor outcome. Biomarker levels of vWF, E38 selectin, thrombomodulin, syndecan-1 and MMP-9 were analysed and compared between groups by a T-test or Mann-Whitney-U test, depending on normality of the data. 

Results: 

Twelve (16.0%) patients developed DCI and 39 (41.9%) patients had poor outcome at six months post-aSAH. None of the biomarkers showed significant differences between patients with and without DCI. vWF and syndecan-1 were elevated on admission and on day 9-11 in patients with poor outcome (p<0.05 and p=0.02, respectively). 

Conclusion: 

Levels of vWF, E-selectin, thrombomodulin, syndecan-1 and MMP-9 were not associated with the occurrence of DCI, although higher levels of vWF and syndecan-1 were associated with poor outcome at six months. Further research is needed to establish the role of these biomarkers in aSAH patients.