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Myeloperoxidase-DNA Serum Titers and Delayed Cerebral Ischemia in Patients With Aneurysmal Subarachnoid Hemorrhage

1Centre for Molecular and Vascular Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium, Leuven, Vlaams-Brabant, Belgium, 2Department of Neurosurgery, Saarland University Medical Center, Homburg/Saar, Germany, Homburg, Saarland, Germany, 3Department of Clinical Chemistry and Laboratory Medicine, Saarland University Medical Center, Homburg/Saar, Germany, Homburg, Saarland, Germany, 4Universitätsklinikum Augsburg, Augsburg, Bayern, Germany, 5Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States

Abstract Number: PB0032

Meeting: ISTH 2022 Congress

Theme: Arterial Thromboembolism » Cerebrovascular Disorders

Background: Myeloperoxidase (MPO)-DNA complexes have been associated with arterial and venous thrombosis. A potential role in patients with aneurysmal subarachnoid hemorrhage (aSAH) is unknown.

Aims: Here, we sought to explore whether serum MPO-DNA-complexes are present in patients with aSAH, and whether levels of serum MPO-DNA complexes are associated with delayed cerebral ischemia (DCI).

Methods: We performed a post-hoc analysis of a prospective, blinded, observational single-center biomarker study that enrolled consecutive patients with spontaneous SAH between July 2018 and September 2020. Serum samples obtained on admission and on hospital day 4 were analyzed for concentrations of MPO-DNA complexes. The primary outcome was the occurrence of DCI defined as new infarction on brain CT-scan. The secondary outcome was clinical vasospasm, a composite of clinical and transcranial doppler parameters. We used Wilcoxon’s signed-rank-test to assess for differences between paired measures.

Results: Among 100 patients with spontaneous SAH, mean age 59 (SD+13) years, 55% women, 78 patients had an aneurysmal SAH and complete DCI information. Among these, 29 (37%) developed DCI. MPO-DNA complexes were detected in all serum samples. The median MPO-DNA level was 33 ng/ml (IQR, 18-43 ng/ml) on admission, and 22 ng/ml (IQR, 11-31 ng/ml) on day 4 (Mann-Whitney test: p=0.015). In the primary outcome analysis, we found a significant reduction in MPO-DNA levels from admission to day 4 in patients with DCI (paired test, p=0.036) but not in those without DCI (p=0.171). The secondary analysis showed a similar reduction in MPO-DNA levels between admission and day 4 in patients with (p=0.006), but not in those without clinical vasospasm (p=0.473).

Conclusion(s): MPO-DNA-complexes are detectable in peripheral serum samples of patients with aSAH. A pronounced reduction in MPO-DNA levels over the first days after aSAH might herald DCI. The potential of MPO-DNA levels to serve as a biomarker of DCI requires further exploration.

Table

Baseline characteristics of the study cohort.

Figure

Change in serum MPO-DNA-levels between admission and hospital day 4 in patients with aneurysmal subarachnoid hemorrhage, stratified by delayed cerebral ischemic -DCI- and clinical vasospasm, respectively.

To cite this abstract in AMA style:

Spalart V, Hendrix P, Oertel J, Hemmer S, Geisel J, Schneider H, Martinod K, Witsch J. Myeloperoxidase-DNA Serum Titers and Delayed Cerebral Ischemia in Patients With Aneurysmal Subarachnoid Hemorrhage [abstract]. https://abstracts.isth.org/abstract/myeloperoxidase-dna-serum-titers-and-delayed-cerebral-ischemia-in-patients-with-aneurysmal-subarachnoid-hemorrhage/. Accessed September 21, 2023.

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