Circulating inflammasome biomarkers provide independent prognostic value beyond clinical scores in aneurysmal subarachnoid hemorrhage

Hegedüs, Emőke and Nagybanyai-Nagy, Blanka and Neuperger, Patricia and Balogh, Fanni and Kari, Beáta and Szebeni, Gábor and Molnár, Tihamér and Csécsei, Péter (2026) Circulating inflammasome biomarkers provide independent prognostic value beyond clinical scores in aneurysmal subarachnoid hemorrhage. JOURNAL OF CLINICAL NEUROSCIENCE, 152. No. 112165. ISSN 0967-5868

Preview

Text Hegedus_E_2026.pdf - Published Version Available under License Creative Commons Attribution. Download (2MB) | Preview

Abstract

Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high mortality and poor functional outcome, driven in part by neuroinflammatory mechanisms. Inflammasome activation has emerged as a key contributor to early brain injury and delayed cerebral ischemia (DCI), yet the prognostic value of circulating inflammasome-related biomarkers remains incompletely defined. This study aimed to evaluate the temporal dynamics and clinical relevance of serum interleukin-18 (IL-18), caspase-1 p20, and gasdermin D N-terminal (GSDMN) in aSAH, and to determine their incremental prognostic value beyond established clinical severity scores.In this single-center prospective observational cohort study, 183 patients with aSAH were enrolled. Serum levels of IL-18, caspase-1 p20, and GSDMN were measured on days 1, 5, and 9 after ictus using ELISA. Clinical severity was assessed using WFNS and modified Fisher scores. The primary outcome was 3-month functional status (modified Rankin Scale). Associations were analyzed using mixed-effects models and multivariable logistic regression adjusted for clinical covariates. Model performance was evaluated using ROC analysis.Caspase-1 p20 levels were significantly elevated in patients and consistently higher in those with unfavorable outcome across all time points. In multivariable analyses, caspase-1 p20 (day 1 and day 5) independently predicted poor outcome and DCI, improving model performance beyond clinical variables (AUC increase from 0.880 to 0.919). IL-18 showed time-dependent changes but lacked independent prognostic significance, while GSDMN levels did not differentiate outcome groups. Longitudinal analyses revealed distinct biomarker trajectories, with significant time-outcome interactions for caspase-1 p20 only.Circulating caspase-1 p20 is a robust and independent biomarker of inflammasome activation with significant prognostic value in aSAH. Its integration into clinical models enhances outcome prediction, supporting its potential role in risk stratification and biomarker-guided therapeutic strategies.

Actions (login required)

View Item