Pilot Exploratory Study of Serum Differential Scanning Calorimetry in Aneurysmal Subarachnoid Hemorrhage Reveals Preliminary Outcome-Related Proteome-Level Thermodynamic Patterns

<b>Background:</b> Aneurysmal subarachnoid hemorrhage (aSAH) induces complex systemic inflammatory and metabolic responses that may influence clinical outcome. DSC provides an integrative biophysical readout of proteome-level thermodynamic behavior rather than protein-specific identification or quantification; however, its applicability in neurocritical conditions remains largely unexplored. This pilot study aimed to explore whether serum DSC profiles show preliminary associations with clinical severity and neurological outcomes after aSAH. <b>Methods</b>: Serum samples collected on day 1 after aSAH were analyzed by DSC and compared with healthy control samples. A small patient cohort was stratified according to clinical severity and neurological outcome. Thermograms were evaluated based on melting temperatures (Tm), calorimetric enthalpy (ΔHcal), heat capacity changes (ΔCp), and the relative contributions of major serum protein components. <b>Results:</b> Healthy controls exhibited characteristic DSC profiles dominated by a cooperative albumin transition at approximately 65-66 °C. In this limited cohort, patients with severe clinical conditions and unfavorable outcomes displayed marked thermogram reorganization, including increased albumin Tm, reduced unfolding cooperativity, decreased ΔCp, and enhanced high-temperature immunoglobulin-related contributions. Patients with mild condition and favorable outcome showed profiles more similar to those of the controls. Notably, patients with severe conditions but favorable outcomes demonstrated heterogeneous albumin-related thermal domains, which may reflect individual-level variability and suggesting dynamic proteomic heterogeneity at the early post-ictus phase. Given the small group sizes, these patterns should be interpreted as exploratory and hypothesis-generating. <b>Conclusions</b>: This pilot exploratory study suggests that serum DSC may capture preliminary thermoanalytical patterns associated with clinical outcomes after aSAH. While the findings indicate the potential of DSC as a systems-level tool in neurocritical care, larger, well-powered studies are required to validate these observations and assess their robustness and generalizability.