A Prospective Cohort Study on Serum A20 As a Prognostic Biomarker of Aneurysmal Subarachnoid Hemorrhage

BACKGROUND:A20 may be a neuroprotective factor.Herein,we aimed to investigate whether serum A20 levels were associated with disease severity,delayed cerebral ischemia(DCI),and outcome after aneurysmal subarachnoid hemorrhage(aSAH).METHODS:In this prospective cohort study containing 112 aSAH patients and 112 controls,serum A20 levels were quantified.At 90 d poststroke,Modified Rankin Scale(MRS)scores≥3 were defined as a poor outcome.All correlations and associations were assessed using multivariate analysis.RESULTS:Compared with controls,there was a significant elevation of serum A20 levels in patients(median 123.7 pg/mL vs.25.8 pg/mL;P<0.001).Serum A20 levels were independently correlated with Hunt-Hess scores(β 9.854;95%confidence interval[95%CI]2.481-17.227,P=0.009)and modified Fisher scores(β 10.349,95%CI 1.273-19.424,P=0.026).Independent associations were found between serum A20 levels and poor outcome(odds ratio[OR]1.015,95%CI 1.000-1.031,P=0.047)and DCI(OR 1.018,95%CI 1.001-1.035,P=0.042).Areas under the curve for predicting poor outcome and DCI were 0.771(95%CI 0.682-0.845)and 0.777(95%CI 0.688-0.850),respectively.Serum A20 levels≥128.15 pg/mL predicted poor outcome,with a sensitivity of 73.9%and specificity of 74.2%,and A20 levels≥160.55 pg/mL distinguished the risk of DCI with 65.5%sensitivity and 89.2%specificity.Its ability to predict poor outcome and DCI was similar to those of Hunt-Hess scores and modified Fisher scores(both P>0.05).CONCLUSION:Enhanced serum A20 levels are significantly associated with stroke severity and poor clinical outcome after aSAH,implying that serum A20 may be a potential prognostic biomarker for aSAH.