Artikel
Proposal on a novel biomarker panel for early diagnosis of delayed cerebral ischemia after subarachnoid haemorrhage
Vorschlag für einen neuen Biomarker-Panel für frühe Erkennung der verzögerten zerebralen Ischämie nach Subarachnoidalblutung
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Veröffentlicht: | 8. Mai 2019 |
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Gliederung
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Objective: Delayed cerebral ischemia (DCI) is a severe complication of subarachnoid hemorrhage (SAH). Clinical and radiographic features of SAH may be helpful in the identification of individuals prone to DCI. The aim of this systematic review was to analyze the present evidence on the predictive value of blood and cerebrospinal fluid (CSF) biomarkers of DCI after SAH.
Methods: We systematically searched in PubMed, Scopus, Web of Science and Cochrane Library databases for publications before July 15, 2018 reporting correlations between blood/CSF biomarkers and occurrence of DCI and/or vasospasm in SAH patients. Included studies underwent quality assessment according to QUIPS and STARD guidelines. Level of evidence (I–IV) for each of tested biomarkers was assessed according to GRADE guidelines
Results: Of 2181 unique records identified in four databases, 270 original articles and 5 meta-analyses were included in this review. Of 257 blood & CSF parameters analyzed in 16.914 SAH patients, there was no biomarker with a positive association with DCI/vasospasm showing the level I evidence. Twenty-one biomarkers achieved the level II evidence and could be confirmed as predictive biomarkers.
Conclusion: In this review, six single nucleotide polymorphisms (for EETs metabolic pathways, COMT, HMGB1, ACE, PAI-1 promoter and Hp genes) and fifteen non-genetic biomarkers (pNF-H, ADAMTS13, NPY, Copeptin, HMGB1, s-GFAP, Periostin, Tau, BNP, NT pro-BNP, hs-TnT, PA-TEGMA, MPV:PLT, NLR and PLR) were selected as predictive DCI biomarkers. We propose that a panel analysis of the selected genetic and protein biomarker candidates would be needed for further validation in a large SAH cohort.