Urinary F2-Isoprostane Concentration as a Poor Prognostic Factor After Subarachnoid Hemorrhage

Abstract

Background: The role of isoprostanes in cerebral vasospasm (CVS) following aneurysmal subarachnoid hemorrhage (aSAH) is controversial. Recent studies have suggested that the level of isoprostanes in cerebrospinal fluid could play a role in outcomes of patients with aSAH. We measured concentration of urinary F₂-isoprostanes (F₂-IsoPs), which is simple and noninvasive.

Methods: A prospective analysis was performed of clinical data and urine samples of 20 patients with aSAH who underwent microsurgical clipping of the aneurysmal neck between May 2016 and January 2017. The role of F₂-IsoPs as a CVS biomarker was analyzed with regard to clinical conditions of patients. Outcome was assessed at discharge and 1-month and 4-month follow-up using the Glasgow Outcome Scale and modified Rankin Scale.

Results: The concentration of urinary F₂-IsoPs was significantly greater in patients with aSAH than in healthy control subjects (P < 0.001). Additionally, increased F₂-IsoP levels on day 3 after aSAH were associated with development of CVS (P = 0.015) and worse neurologic performance after 1 month (P = 0.042) and 4 months (P = 0.027). The prognostic value of urinary F₂-IsoPs on day 3 in terms of CVS was found to be high (area under the curve 0.864, 95% confidence interval 0.691-1.000).

Conclusions: Urinary F₂-IsoPs may be used as a noninvasive prognostic biochemical marker in patients with aSAH. F₂-IsoP levels in urine may have significant implications in pathogenesis of CVS.

Keywords: Aneurysmal subarachnoid hemorrhage; Cerebral vasospasm; F(2)-isoprostanes; Reactive oxygen species.