Explorative Values of Ubiquitin Carboxy-Terminal Hydrolase L1 in Spontaneous Subarachnoid Hemorrhage: Prediction of Clinical Outcomes and Delayed Cerebral Ischemia

BACKGROUND AND OBJECTIVES: Spontaneous subarachnoid hemorrhage (sSAH) is a critical neurological condition with high mortality and significant long-term sequelae. Delayed cerebral ischemia (DCI) is a significant contributor to poor clinical outcomes. Despite advances in management, early predictors of clinical outcomes and DCI remain unclear. This study investigates whether serum ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), a neuronal injury biomarker, can predict functional outcomes, mortality, and DCI in patients with sSAH. METHODS: A prospective observational study was conducted from January 2022 to June 2024, enrolling adults (≥18 years) with sSAH confirmed by neuroimaging on admission. Blood samples were collected at 24 hours (T0), 72 hours (T1), and 7 days (T2) after sSAH onset. UCH-L1 levels were measured using an automated analyzer. Outcomes were functional status, assessed by the modified Rankin Scale at 14 days and 3 months, mortality, the occurrence of DCI, and determination of UCH-L1 cutoff values predictive of poor prognosis. RESULTS: A total of 102 patients with sSAH were included. UCH-L1 levels measured 24 hours after admission were independent predictors of poor outcomes ( P < .001) and DCI ( P = .026). The optimal UCH-L1 cutoff for predicting poor outcomes at 14 days and 3 months was 174.6 pg/mL (odds ratio 10.55, 95% CI 4.23-26.36 and odds ratio 7.79, 95% CI 3.11-19.52, respectively). CONCLUSION: Early serum UCH-L1 levels are significant predictors of clinical outcomes, mortality, and DCI in patients with sSAH, suggesting that UCH-L1 could be a promising biomarker for guiding early prophylactic and therapeutic interventions in the management of sSAH.