Early stage neuroglobin level as a predictor of delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage

BACKGROUND: The neuroglobin (Ngb) is well recognized as a potential biomarker for the hypoxic‐ischemic brain injury. However, connection between Ngb and delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage (aSAH) is still unclear. OBJECTIVE: To investigate the relationship between early stage Ngb level of aSAH patient and the occurrence of DCI. METHODS: We evaluated 126 aSAH patients who were enrolled into a prospective observational cohort study. Serum Ngb level on days 1, 2, 3, 5, and 7 after aSAH were determined using a commercial enzyme‐linked immunosorbent assay kit. The relationship between Ngb level and DCI was analyzed. RESULTS: Forty‐six (36.5%) aSAH patients experienced DCI. Patients with DCI had significantly higher Ngb levels than those without (p < .001). Multivariate model analysis revealed that day 3 Ngb level remained a significant factor after adjusting for World Federation of Neurosurgical Societies (WFNS) grade, modified Fisher grade, clipping and Ngb levels on days 1, 2, 5, and 7. Sensitivity, specificity, and Youden index of day 3 Ngb level for identifying DCI were derived as 73.9%, 72.5%, and 0.46, respectively, based on the best threshold of 8.4 ng/ml. Regardless in good‐grade group or in poor‐grade group, patients having day 3 Ngb level > 8.4 ng/ml has a significantly worse DCI survival rate than those having day 3 Ngb level <=8.4 ng/ml (p = .026 and .009, respectively). CONCLUSIONS: Serum Ngb level was significantly elevated in DCI patients. Early stage aSAH Ngb level has the potential of being used as a novel DCI occurrence predictor, especially when Ngb level was combined with WFNS grade.