Early and delayed blood-brain barrier permeability predicts delayed cerebral ischemia and outcomes following aneurysmal subarachnoid hemorrhage

Objectives This study aimed to monitor blood-brain barrier permeability within 24 h and during the delayed cerebral ischemia (DCI) time window (DCITW) spanning 4–14 days after aneurysmal subarachnoid hemorrhage (aSAH) and to investigate its correlation with both DCI occurrence and outcomes at three months. Methods A total of 128 patients were stratified based on the DCI occurrence and three-month modified Rankin scale scores. Comparison of K trans at admission (admission K trans ) and during DCITW (DCITW K trans ) was conducted between DCI and non-DCI groups, as well as between groups with good and poor outcomes. Changes in K trans were also analyzed. Multivariate logistic regression analysis was performed to identify independent predictors of DCI and poor outcomes. Results Admission K trans (0.58 ± 0.18 vs 0.47 ± 0.12, p = 0.002) and DCITW K trans (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. Although both were higher in the poor outcome group than the good outcome group, the difference was not statistically significant at admission (0.53 ± 0.18 vs 0.49 ± 0.14, p = 0.198). K trans 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 the admission to DCITW. Multivariate analysis identified DCITW K trans and admission K trans as independent predictors of poor outcomes (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. Conclusion Elevated K trans at admission is associated with the occurrence of DCI. Continuous monitoring of K trans from admission to DCITW can accurately identify reversible and irreversible changes and can predict outcomes at 3 months. Clinical relevance statement K trans measured with CT perfusion is a valuable tool for predicting both delayed cerebral ischemia and three-month outcomes following aneurysmal subarachnoid hemorrhage. Monitoring changes in K trans from admission to time window of delayed cerebral ischemia can guide treatment and management decisions for aneurysmal subarachnoid hemorrhage patients. Key Points • K trans measured at admission and during the delayed cerebral ischemia time window (4–14 days) holds distinct clinical significance following aneurysmal subarachnoid hemorrhage. • Admission K trans serves as a predictor for delayed cerebral ischemia, while continuous assessment of K trans from admission to the delayed cerebral ischemia time window can predict three-month outcomes. • Monitoring K trans at different stages improves instrumental in enhancing decision-making and treatment planning for patients with aneurysmal subarachnoid hemorrhage.