Abstract Number: Esoc2026a1131 a Biomarker Coming of Age: Skin Autofluorescence Predicts Functional Outcome After Aneurysmal Subarachnoid Hemorrhage

Abstract Background and aims Risk stratification after aneurysmal subarachnoid hemorrhage (aSAH) remains challenging. Beyond hemorrhage severity, chronic metabolic vulnerability may contribute to secondary brain injury. Skin autofluorescence (SAF) is a non-invasive bedside biomarker reflecting tissue accumulation of advanced glycation end products (AGEs). Its prognostic relevance after aSAH is undertermined. Methods In this prospective single-center cohort study, SAF was measured in consecutive adults with confirmed aSAH. The primary endpoint was poor functional outcome at 90 days (modified Rankin Scale mRS 4–6). Secondary endpoints were delayed cerebral ischemia (DCI; delayed neurological deterioration ≥1 hour and/or new cerebral infarction not attributable to other causes) and radiographic vasospasm. Associations were assessed using logistic regression and receiver operating characteristic (ROC) analyses. Results Fifty patients completed 90-day follow-up; 22 (44%) had poor functional outcome. SAF was strongly associated with poor outcome (logistic regression coefficient 2.28, P = 0.001), corresponding to an odds ratio of 9.8 per unit increase. Discriminative performance was excellent (AUC 0.81). An optimal SAF cut-off ≥2.6 yielded sensitivity 0.82, specificity 0.71, positive predictive value 0.69, and negative predictive value 0.83. SAF showed a moderate association with DCI (P = 0.045; AUC 0.68) but was not associated with radiographic vasospasm (P = 0.35). Results remained robust after adjustment for baseline disease severity. Conclusions Bedside SAF strongly predicts poor 90-day functional outcome after aSAH and is associated with delayed cerebral ischemia but not large-vessel vasospasm. These findings support a role of chronic metabolic vulnerability in secondary brain injury. External validation in larger multicenter cohorts is warranted. Conflict of interest All authors have nothing to disclose related to this abstract.