Plasma Periostin and Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage

  • Hideki Kanamaru
  • Fumihiro Kawakita
  • Fumi Nakano
  • Yoichi Miura
  • Masato Shiba
  • Ryuta Yasuda
  • Naoki Toma
  • Hidenori SuzukiEmail author
  • pSEED group
Original Article


Delayed cerebral ischemia (DCI) is a serious complication of aneurysmal subarachnoid hemorrhage (SAH). Matricellular protein periostin (POSTN) has been found to be upregulated and linked with early brain injury after experimental SAH. The aim of the present study was to investigate the relationship between plasma POSTN levels and various clinical factors including serum levels of C-reactive protein (CRP), an inflammatory marker, in 109 consecutive SAH patients whose POSTN levels were measured at days 1–12 after aneurysmal obliteration. DCI developed in 16 patients associated with higher incidence of angiographic vasospasm, cerebral infarction, and 90-day worse outcomes. POSTN levels peaked at days 4–6 before DCI development. Cerebrospinal fluid (CSF) drainage was associated with reduced POSTN levels, but did not influence CRP levels. There was no correlation between POSTN levels and other treatments or CRP levels. To predict DCI development, receiver-operating characteristic curves indicated that the most reasonable cutoff POSTN levels were obtained at days 1–3 in patients without CSF drainage (80.5 ng/ml; specificity, 77.6%; sensitivity, 85.7%). Multivariate analyses using variables obtained by day 3 revealed that POSTN level was an independent predictor of DCI. POSTN levels over the cutoff value were associated with higher incidence of DCI, but not angiographic vasospasm. This study shows for the first time that CSF drainage may reduce plasma POSTN levels, and that POSTN levels may increase prior to the development of DCI with and without vasospasm irrespective of systemic inflammatory reactions in clinical settings. These findings suggest POSTN as a new therapeutic molecular target against post-SAH DCI.

Key Words

Cerebrospinal fluid drainage delayed cerebral ischemia matricellular protein periostin subarachnoid hemorrhage 



We thank Ms. Chiduru Nakamura (Department of Neurosurgery, Mie University Graduate School of Medicine) for her technical assistance. This work was funded by a grant-in-aid for Scientific Research from Japan Society for the Promotion of Science (grant number: 17K10825) to Dr. Suzuki.

Members along with their affiliations listed in Supplementary Material (Appendix).

Required Author Forms

Disclosure forms provided by the authors are available with the online version of this article.

Compliance with Ethical Standards

The Institutional Ethics Committee approved the study, and written informed consent was obtained from the relatives.

Supplementary material

13311_2018_707_MOESM1_ESM.pdf (2 mb)
ESM 1 (PDF 2028 kb)
13311_2018_707_MOESM2_ESM.pdf (326 kb)
ESM 2 (PDF 326 kb)


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Copyright information

© The American Society for Experimental NeuroTherapeutics, Inc. 2019

Authors and Affiliations

  1. 1.Department of NeurosurgeryMie University Graduate School of MedicineTsuJapan
  2. 2.Center for Vessels and HeartMie University HospitalTsuJapan

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