Neutrophils extracellular traps myeloperoxidase and elastase predict cerebral vasospasms after aneurysmal subarachnoid hemorrhage

Aneurysmal subarachnoid hemorrhage (aSAH) is a highly fatal and morbid disease. Despite successful coiling or clipping of a ruptured aneurysm, the patients suffer post-aSAH complications, including early brain injury, cerebral vasospasm (CVS), delayed cerebral ischemia (DCI), and systemic infections that mainly determine the clinical outcomes. Diagnostic biomarkers to predict accurately post-aSAH complications are needed. In this prospective exploratory study, we investigated the predictive value of neutrophil extracellular traps (NETs) components for CVS after aSAH. In the study, 62 patients with aSAH, 17 patients with unruptured cerebral aneurysms, and 12 healthy controls were included. The serum levels of myeloperoxidase (MPO), elastase (ELA), and citrullinated histone H3 (cH3) on day 1 and day 4 of hospital admission were measured with ELISA. Data were scaled using the Yeo-Johnson transformation. Values in two groups were compared using a <i>t</i>-test and in multiple groups using ANOVA. Logistic regression was used to model the outcome probability, including CVS, as the function of ELISA values. Among the patients with aneurysms, those who suffered aSAH had significantly higher levels of MPO (113.9 ± 294.4 vs. 422.3 ± 319.0 ng/ml, p < 0.05), ELA (84.8 ± 221.0 vs. 199.2 ± 218.9 ng/ml, p < 0.05), and cH3 (0.0 ± 0.0 vs. 2.8 ± 1.5, ng/ml, p < 0.05) on day one after aSAH, suggesting the involvement of NETs components in pathophysiology of aSAH and the events following aSAH. Individually, MPO and ELA levels taken on day 1 after SAH did not differ between patients with CVS and patients without CVS. However, when taken together into a logistic model, they allowed for predicting CVS with high sensitivity (91 %) and specificity (79 %). MPO and ELA, along with other clinical parameters, can be used as early predictors of CVS in aSAH patients and can serve as guidance during treatment decisions in the management of aSAH.