Early serum metabolomics distinguished delayed cerebral ischemia from non-DCI aneurysmal subarachnoid hemorrhage in a small retrospective cohort.
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Key Takeaway
Note that early metabolomic profiles distinguish DCI from non-DCI aSAH, but validation is required.
This retrospective cohort study analyzed serum metabolomic profiles within 24 hours of aneurysmal subarachnoid hemorrhage (aSAH) in a single-center Chinese population. The cohort included 44 patients, stratified into 22 with DCI and 22 without DCI. Clinical predictors of DCI were identified as vasospasm and age, which served as independent predictors in the analysis.
The study assessed aneurysm morphological parameters and found no significant differences between the DCI and non-DCI groups. Metabolic profile analysis revealed clear separation between the two cohorts, supported by permutation testing with an R2 of 0.6485 and a Q2 intercept of -0.4173. A total of 110 differential metabolites were identified, with 39 upregulated and 71 downregulated in the DCI group (two-sided P < 0.05).
No adverse events, serious adverse events, discontinuations, or specific tolerability data were reported. Key limitations include the retrospective design, small sample size of 44 patients, and the single-center nature of the Chinese cohort. These factors, combined with the exploratory nature of the findings, suggest that current results are association-only and not definitive for clinical utility.
The practice relevance of this study lies in its potential to inform future biomarker development. However, targeted validation in larger, diverse populations is necessary before these metabolic signatures can be considered for routine clinical decision-making regarding DCI risk stratification.
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View Original Abstract ↓
BackgroundDelayed cerebral ischemia (DCI) remains a major determinant of poor outcomes after aneurysmal subarachnoid hemorrhage (aSAH), yet early risk stratification is challenging.MethodsA retrospective cohort of 44 aSAH patients was analyzed (DCI, n = 22; non-DCI, n = 22). Serum collected within 24 h of admission underwent untargeted liquid chromatography–tandem mass spectrometry metabolomics. Between-group separation was evaluated using supervised multivariate modeling with permutation testing. Differential metabolites were identified using a combined multivariate and univariate strategy (two-sided P < 0.05), followed by pathway enrichment analysis. Independent clinical predictors were assessed using multivariate logistic regression, and aneurysm morphology was quantified on admission CT angiography using radiomics-derived parameters.ResultsThe DCI group was older, had a higher proportion of females, worse admission neurological status, higher vasospasm incidence, and lower hemoglobin. Vasospasm and age were independent predictors. Aneurysm morphological parameters showed no between-group differences. Metabolic profiles showed clear separation, supported by permutation testing (R2 = 0.6485; Q2 intercept = −0.4173). A total of 110 differential metabolites were identified (39 upregulated and 71 downregulated in DCI). Representative changes included increased sphinganine, 2-octenoylcarnitine, guanidoacetic acid, and 5-aminopentanoic acid, with decreased lysophosphatidylcholine 16:0, lysophosphatidylethanolamine 16:0, xanthine, and dehydroepiandrosterone sulfate. Enrichment highlighted coordinated alterations in energy-related, amino-acid, and nucleotide-related pathways.ConclusionEarly serum metabolomics within 24 h after aSAH revealed a DCI-associated systemic metabolic signature, supporting the identification of exploratory serum metabolic features associated with DCI in a Chinese cohort, which may inform future biomarker development following targeted validation.
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