Cerebrospinal fluid haemoglobin as a monitoring biomarker for secondary brain injury after aneurysmal…

Cohort studyJournal of neurology, neurosurgery, and psychiatry· Jul 2026

Cerebrospinal fluid haemoglobin as a monitoring biomarker for secondary brain injury after aneurysmal subarachnoid haemorrhage: prospective international multicentre validation study (HeMoVal).

Kevin Akeret, Raphael Matthias Buzzi, Thomas Gentinetta … HeMoVal Research Group

CerebrovascularCohort studyQ1IF 6.6

Cerebrospinal fluid haemoglobin poorly discriminates same-day secondary brain injury after subarachnoid haemorrhage

Cerebrospinal fluid haemoglobin as a monitoring biomarker for secondary brain injury after aneurysmal subarachnoid haemorrhage: prospective international multicentre validation study (HeMoVal).

Kevin Akeret … HeMoVal Research Group

Journal of neurology, neurosurgery, and psychiatry · Jul 2026 · Q1 in Surgery

Purpose

To validate whether cerebrospinal fluid oxyhaemoglobin (CSF-Hb), measured from external ventricular or lumbar drains, is associated with secondary brain injury (SAH-SBI) after aneurysmal subarachnoid haemorrhage (aSAH) and to assess its value as a real-time monitoring biomarker.

Methods

366 patients with aSAH (mean age 58 years; 65% women).

n = 2467 samples

Results

correctly flags same-day brain injury only slightly better than chance

OR 1.18 (95% CI 1.02 to 1.36)

null 1

1.02

1.36

CI excludes the null - significant

More results

CSF-Hb showed a delayed peak pattern: concentrations were low after aSAH, rose to a maximum on day 10 (EVD-derived CSF-Hb median 11.3 µM, IQR 2.64 to 25.90) and then declined.

Larger haematoma volume (p<0.001) and intraventricular haemorrhage (p<0.001) were associated with higher EVD-derived CSF-Hb.

More results

In a post-hoc exploratory analysis, higher cerebrospinal fluid methaemoglobin showed a positive point-estimate of association with SAH-SBI (OR 1.18 per log(µM), 95% CI 1.02 to 1.36).

Higher acute-phase EVD-derived CSF-Hb was associated with chronic hydrocephalus and a poor 3 month functional outcome.

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Conclusion · 1 of 2

In this preregistered multicentre validation study, EVD-derived CSF-Hb did not perform as a robust real-time monitoring biomarker for SAH-SBI, showing limited same-day discrimination and substantial between-centre heterogeneity.

Conclusion · 2 of 2

These findings argue against clinical implementation of CSF-Hb point-measurement as a single-parameter biomarker.

Cerebrospinal fluid haemoglobin as a monitoring biomarker for secondary brain injury after aneurysmal subarachnoid haemorrhage: prospective international multicentre validation study (HeMoVal).

Cerebrospinal fluid haemoglobin as a monitoring biomarker for secondary brain injury after aneurysmal subarachnoid haemorrhage: prospective international multicentre validation study (HeMoVal).

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