Prediction and prognosis of delayed cerebral ischemia via continuous monitoring of blood-brain barrier permeability

BackgroundBlood-brain barrier disruption is a prominent pathological characteristic of aneurysmal subarachnoid hemorrhage (aSAH), which can be measured as Ktrans using CT perfusion. PurposeTo monitor Ktrans within 24 hours of aSAH and during the time window associated with a delayed cerebral ischemia (DCI) event (DCITW), and to explore its association with the trajectory of DCI, including outcome at three months. MethodsWe retrospectively assessed consecutive aSAH patients from a prospective database between July 2020 and September 2022. Patients were grouped according to the DCI occurrence and three months modified Rankin scale. Ktrans at admission (admission Ktrans) and during DCITW (DCITW Ktrans) were compared between DCI and non-DCI groups, and between good outcome and poor outcome groups. The changes in Ktrans were also analyzed. Multivariate logistic regression analysis was performed to identify independent predictors of DCI and poor outcome. ResultsOne hundred and twenty-eight patients (mean age, 61{+/-}12 [SD]; 75 women) were included. Both admission Ktrans (0.58{+/-}0.18 vs 0.47{+/-}0.12, P=0.002) and DCITW Ktrans (0.54{+/-}0.19 vs 0.41{+/-}0.14, P<0.001) were significantly higher in the DCI group compared with the non-DCI group. Both of those were also higher in the poor outcome group compared with the good outcome group, but the difference was not statistically significant at admission (0.53{+/-}0.18 vs0.49{+/-}0.14, P=0.198). Ktrans in the non-DCI group (0.47{+/-}0.12 vs 0.41{+/-}0.14, P=0.004) and good outcome group (0.49{+/-}0.14 vs 0.41{+/-}0.14, P<0.001) decreased significantly from admission to DCITW. Multivariate analysis identified DCITW Ktrans and admission Ktrans as independent predictors of poor outcome (OR=1.73, 95%CI: 1.24-2.43, P=0.001) and DCI (OR=1.75, 95%CI: 1.25-2.44, P=0.001), respectively. ConclusionElevated Ktrans at admission is associated with the occurrence of DCI, but not with outcome at three months. Continuous monitoring of Ktrans from admission to DCITW can accurately identify reversible and irreversible changes in Ktrans, and can predict outcome.