Blood-based biomarkers for predicting prognosis in patients with subarachnoid hemorrhage: a systematic review and network meta-analysis.

BACKGROUND: This network meta-analysis aimed to evaluate the predictive value of different blood biomarkers for the prognosis of patients with subarachnoid hemorrhage. METHODS: PubMed, Embase, Cochrane Library, and Web of Science databases were searched to collect relevant studies published in the last decade. Included studies reported sensitivity or specificity. The quality of included studies was assessed using the QUADAS-2 tool, and network meta-analysis was performed using STATA 18.0. The area under the cumulative ranking curve was calculated to compare the diagnostic efficacy of different biomarkers. RESULTS: A total of 38 studies involving 53 blood biomarkers were included. Among inflammatory markers, cleaved receptors for advanced glycation end-products (cRAGE) (SUCRA: sensitivity 75.9%, specificity 45.4%) showed relatively high predictive efficacy. Among immune cell counts, the fibrinogen and neutrophil-to-lymphocyte ratio (F-NLR) (SUCRA: sensitivity 69.4%, specificity 37.1%) performed particularly well. Among electrolytes and metabolites, maximum sodium concentration (Na+max) (SUCRA: sensitivity 80.6%, specificity 18.6%) showed good predictive ability. Cluster analysis indicated that soluble scavenger receptor A (sSRA) among inflammatory markers, the monocyte-to-lymphocyte ratio (MLR) among immune cell counts, and Na⁺ among electrolytes and metabolites have high comprehensive diagnostic value. Subgroup and sensitivity analyses confirmed the robustness of these findings, though results for electrolytes varied across different clinical settings. CONCLUSION: cRAGE, F-NLR, and Na⁺max show relatively high sensitivity or specificity and may be considered as the preferred indicators in future clinical research and practice.