The Role of Consecutive Plasma Copeptin Levels in the Screening of Delayed Cerebral Ischemia in Poor-Grade Subarachnoid Hemorrhage

The prognostic value of copeptin in subarachnoid hemorrhage (SAH) has been reported, but the prognosis was largely affected by the initial clinical severity. Thus, the previous studies are not very useful in predicting delayed cerebral ischemia (DCI) in poor-grade SAH patients. Here, we first investigated the feasibility of predicting DCI in poor-grade SAH based on consecutive measurements of plasma copeptin. We measured copeptin levels of 86 patients on days 1, 3, 5, 7, 9, 11, and 13 using ELISA. The primary outcome was the association between consecutive copeptin levels and DCI development. The secondary outcomes were comparison of copeptin with C-reactive protein (CRP) in predicting DCI. Additionally, we compared the prognostic value of transcranial Doppler ultrasonography (TCD) with copeptin using TCD alone to predict DCI. Increased copeptin (OR = 1.022, 95% CI: 1.008–1.037) and modified Fisher scale IV (OR = 2.841; 95% CI: 0.998–8.084) were closely related to DCI. Consecutive plasma copeptin measurements showed significant differences between DCI and non-DCI groups (p < 0.001). Higher CRP and DCI appeared to show a correlation, but it was not statistically significant. Analysis of copeptin changes with TCD appeared to predict DCI better than TCD alone with AUCROC differences of 0.072. Consecutive measurements of plasma copeptin levels facilitate the screening of DCI in poor-grade SAH patients.

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Monitoring of Delayed Cerebral Ischemia in Patients with Subarachnoid Hemorrhage via Near-Infrared Spectroscopy

Journal of Clinical Medicine ◽

10.3390/jcm9051595 ◽

2020 ◽

Vol 9 (5) ◽

pp. 1595

Author(s):

Jeong Jin Park ◽

Chulho Kim ◽

Jin Pyeong Jeon

Keyword(s):

Infrared Spectroscopy ◽

Subarachnoid Hemorrhage ◽

Cerebral Ischemia ◽

Diagnostic Accuracy ◽

Near Infrared Spectroscopy ◽

Doppler Ultrasonography ◽

Near Infrared ◽

Delayed Cerebral Ischemia ◽

Feasible Method

We investigated the role of near infrared spectroscopy (NIRS) in identifying delayed cerebral ischemia (DCI) in patients with subarachnoid hemorrhage (SAH). We measured the cerebral regional oxygen saturation (rSO2) continuously for 14 days. The differences in rSO2 according to DCI were analyzed. We also compared the diagnostic accuracy of NIRS and transcranial Doppler ultrasonography (TCD) for DCI detection using the area under receiver operator characteristic (ROC) curve. Fifty-two patients treated with coil embolization were enrolled, including 18 with DCI (34.6%) and 34 without DCI (65.4%). Significant differences in rSO2 levels were observed from days 7 to 9. The rSO2 level was 60.95 (58.10–62.30) at day 7 in the DCI vs. 63.90 (62.50–67.10) in the non-DCI patients. By day 8, it was 59.50 (56.90–64.50) in the DCI vs. 63.30 (59.70–68.70) in the non-DCI cases. By day 9, it was 61.85 (59.40–65.20) in the DCI vs. 66.00 (62.70–68.30) in the non-DCI. A decline of >12.7% in SO2 rate yielded a sensitivity of 94.44% (95% CI: 72.7–99.9%) and a specificity of 70.59% (95% CI: 52.5–84.9%) for identifying DCI. Changes in NIRS tended to yield better diagnostic accuracy than TCD, but were not statistically significant. NIRS is a feasible method for real-time detection of DCI.

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Faculty Opinions recommendation of Cerebral Autoregulation in the Prediction of Delayed Cerebral Ischemia and Clinical Outcome in Poor-Grade Aneurysmal Subarachnoid Hemorrhage Patients.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.732595998.793542399 ◽

2018 ◽

Author(s):

Stephan Mayer

Keyword(s):

Subarachnoid Hemorrhage ◽

Cerebral Ischemia ◽

Clinical Outcome ◽

Cerebral Autoregulation ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Delayed Cerebral Ischemia ◽

Poor Grade

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Application of Near-Infrared Spectroscopy for the Detection of Delayed Cerebral Ischemia in Poor-Grade Subarachnoid Hemorrhage

Neurocritical Care ◽

10.1007/s12028-021-01318-w ◽

2021 ◽

Author(s):

Indu Kapoor ◽

Charu Mahajan ◽

Hemanshu Prabhakar

Keyword(s):

Infrared Spectroscopy ◽

Subarachnoid Hemorrhage ◽

Cerebral Ischemia ◽

Near Infrared Spectroscopy ◽

Near Infrared ◽

Delayed Cerebral Ischemia ◽

Poor Grade

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Role of Endothelin-1 in Human Aneurysmal Subarachnoid Hemorrhage: Associations with Vasospasm and Delayed Cerebral Ischemia

Neurocritical Care ◽

10.1007/s12028-011-9508-9 ◽

2011 ◽

Vol 15 (1) ◽

pp. 19-27 ◽

Cited By ~ 30

Author(s):

Bhavani P. Thampatty ◽

Paula R. Sherwood ◽

Matthew J. Gallek ◽

Elizabeth A. Crago ◽

Dianxu Ren ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Cerebral Ischemia ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Delayed Cerebral Ischemia ◽

Endothelin 1

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Impact of Early Leukocytosis and Elevated High-Sensitivity C-Reactive Protein on Delayed Cerebral Ischemia and Neurologic Outcome After Subarachnoid Hemorrhage

World Neurosurgery ◽

10.1016/j.wneu.2016.02.049 ◽

2016 ◽

Vol 90 ◽

pp. 91-95 ◽

Cited By ~ 28

Author(s):

Anirudh Srinivasan ◽

Ashish Aggarwal ◽

Sachin Gaudihalli ◽

Manju Mohanty ◽

Manju Dhandapani ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Cerebral Ischemia ◽

Delayed Cerebral Ischemia ◽

High Sensitivity ◽

Neurologic Outcome ◽

C Reactive Protein ◽

Reactive Protein

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Frequency and clinical impact of asymptomatic cerebral infarction due to vasospasm after subarachnoid hemorrhage

Journal of Neurosurgery ◽

10.3171/jns.2008.109.12.1052 ◽

2008 ◽

Vol 109 (6) ◽

pp. 1052-1059 ◽

Cited By ~ 104

Author(s):

J. Michael Schmidt ◽

Katja E. Wartenberg ◽

Andres Fernandez ◽

Jan Claassen ◽

Fred Rincon ◽

...

Keyword(s):

Risk Factors ◽

Subarachnoid Hemorrhage ◽

Cerebral Ischemia ◽

Cerebral Infarction ◽

Clinical Symptoms ◽

External Ventricular Drain ◽

Delayed Cerebral Ischemia ◽

Neurological Deterioration ◽

Modified Rankin Scale ◽

Poor Grade

Object The authors sought to determine frequency, risk factors, and impact on outcome of asymptomatic cerebral infarction due to vasospasm after subarachnoid hemorrhage (SAH). Methods The authors prospectively studied 580 patients with SAH admitted to their center between July 1996 and May 2002. Delayed cerebral ischemia (DCI) from vasospasm was defined as 1) a new focal neurological deficit or decrease in level of consciousness, 2) a new infarct revealed by follow-up CT imaging, or both, after excluding causes other than vasospasm. Outcome at 3 months was assessed using the modified Rankin Scale. Results Delayed cerebral ischemia occurred in 121 (21%) of 580 patients. Of those with DCI, 36% (44 patients) experienced neurological deterioration without a corresponding infarct, 42% (51 patients) developed an infarct in conjunction with neurological deterioration, and 21% (26 patients) had a new infarct on CT without concurrent neurological deterioration. In a multivariate analysis, risk factors for asymptomatic DCI included coma on admission, placement of an external ventricular drain, and smaller volumes of SAH (all p ≤ 0.03). Patients with asymptomatic DCI were less likely to be treated with vasopressor agents than those with symptomatic DCI (64 vs 86%, p = 0.01). After adjusting for clinical grade, age, and aneurysm size, the authors found that there was a higher frequency of death or moderate-to-severe disability at 3 months (modified Rankin Scale Score 4–6) in patients with asymptomatic DCI than in patients with symptomatic DCI (73 vs 40%, adjusted odds ratio 3.9, 95% confidence interval 1.3–12.0, p = 0.017). Conclusions Approximately 20% of episodes of DCI after SAH are characterized by cerebral infarction in the absence of clinical symptoms. Asymptomatic DCI is particularly common in comatose patients and is associated with poor outcome. Strategies directed at diagnosing and preventing asymptomatic infarction from vasospasm in patients with poor-grade SAH are needed.

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