Additive prognostic impact of the cerebrospinal fluid arginine/ornithine ratio to established clinical scores in aneurysmal subarachnoid hemorrhage

Johannes Weller; Tim Lampmann; Harun Asoglu; Matthias Schneider; Stefan Felix Ehrentraut; Felix Lehmann; Erdem Güresir; Franziska Dorn; Gabor C Petzold; Hartmut Vatter; Julian Zimmermann

doi:10.3389/fneur.2023.1156505

Additive prognostic impact of the cerebrospinal fluid arginine/ornithine ratio to established clinical scores in aneurysmal subarachnoid hemorrhage

Front Neurol. 2023 Apr 14:14:1156505. doi: 10.3389/fneur.2023.1156505. eCollection 2023.

Authors

Affiliations

¹ Department of Neurology, University Hospital Bonn, Bonn, Germany.
² Department of Neurosurgery, University Hospital Bonn, Bonn, Germany.
³ Department of Anesthesiology, University Hospital Bonn, Bonn, Germany.
⁴ Department of Neuroradiology, University Hospital Bonn, Bonn, Germany.
⁵ German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.

Abstract

Cerebrospinal fluid (CSF) metabolites are increasingly recognized as prognostic factors in aneurysmal subarachnoid hemorrhage (SAH). The CSF arginine/ornithine ratio (Arg/Orn) was shown to predict cerebral vasospasms and clinical outcome in SAH. The additive prognostic value of Arg/Orn over established prognostic scores has not been investigated. CSF Arg/Orn and the established prognostic scores SAH, FRESH, SAH-PDS, HAIR, Rosen-McDonald, Hunt and Hess, WFNS and modified Fisher scale were determined in a prospective cohort of patients with aneurysmal SAH. Logistic regression models to predict a favorable outcome, defined as a modified Rankin Scale score of 0-3 at 3 months follow-up, were constructed for each score, both with and without the addition of Arg/Orn. The impact of Arg/Orn was assessed comparing logistic regression models containing the respective score with and without Arg/Orn with the likelihood ratio chi-squared test. CSF Arg/Orn and clinical scores were determined in 38 SAH patients. Arg/Orn was an independent predictor of clinical outcome when added to established prognostic scores (p < 0.05) with the exception of HAIR (p = 0.078). All models were significantly improved if Arg/Orn was added as a covariable (p < 0.05). The results of this study confirm Arg/Orn as an independent prognostic factor and its addition improves established prognostic models in SAH.

Keywords: arginase 1; arginine (PubChem CID: 6322); cerebrospinal fluid; ornithine (PubChem CID: 6262); outcome prognostication; scores accuracy; subarachnoid hemorrhage.