Clinical Neurology and Neurosurgery 199 (2020) 106296 Available online 7 October 2020 0303-8467/© 2020 Elsevier B.V. All rights reserved. Predictive value of haptoglobin genotype as a risk of cerebral vasospasm after aneurysmal subarachnoid hemorrhage Ahmed Mohammed Ateia a, *, Ahmed Elbassiouny b , Sobhy Hassab El-Nabi c , Nagia Aly Fahmy d , Mahmoud Haroon Ibrahim d , Islam El-Garawani c , Khaled Mohammed Geba c , Magdy Khalaf a a Department of Neurology, El Matareya Educational Hospital, Egypt b Department of Intervention Neurology, Faculty of Medicine, Ain Shams University, Egypt c Department of Zoology, Molecular Biology and Genetics Unit, Faculty of Science, Menoufa University, Egypt d Department of Neurology, Faculty of Medicine, Ain Shams University, Egypt A R T I C L E INFO Keywords: Subarachnoid hemorrhage Haptoglobin Vasospasm ABSTRACT Objective: This study aims to investigate the genetic predisposition of haptoglobin (Hp) genotype as a predictor for cerebral vasospasm (CV) after acute subarachnoid hemorrhage (aSAH) in the Egyptian population. This permits CV risk factors stratifcation of patients with aSAH. Hence, it will guide the treatment plan and intensive monitoring for those patients. Patients and Methods: The study was carried out at El Matareya Teaching Hospital, Cairo, Egypt. We studied 50 patients with aSAH who were prospectively recruited and followed up by transcranial Doppler (TCD) exami- nation for 14 days following aneurysmal rupture to early detect hemodynamic changes associated with CV and also the occurrence of delayed cerebral ischemia (DCI) as a secondary outcome. In this study, we attempted to analyze Hp genotyping as a potential predictor of CV and DCI during the acute phase of aneurysmal SAH. Results: As a part of result analyses, among studied patients, 34 patients (68 %) developed CV and 19 patients (38 %) developed DCI. Only history of hypertension [RR = 1.6 (OR = 4)], diabetes mellitus [RR = 1.5 (OR = 3.4)] and smoking [RR = 1.5 (OR = 3.6)] had a signifcant independent relationship (P < 0.05) with short term risk to develop CV following aSAH. While, Age, sex, hyperlipidemia, cardiovascular disease and peripheral vascular disease, intracranial aneurysm site and size did not achieve signifcant association for developing CV. Regarding the poor Fisher scale and poor Hunt and Hess score both showed signifcant association with CV (P < 0.05). Genotyping of Hp protein among our study cohort revealed that the relative distribution of the three haptoglobin genotypes (Hp11, HP2-I & HP22) among Egyptian patients of aSAH was 14 %, 40 % and 46 %, respectively; (gene proportion being 0.34 for Hp1 and 0.66 for Hp2). Furthermore; Hp 2 allele was associated with radio- graphic vasospasm detected by TCD among the studied patients (22 & 21 Vs 11: RR = 5.4, OR = 19.8, P < 0.001). In the regression model; Hp genotype expressing Hp-2 allele is predictive for higher risk of development of CV after aSAH. Moreover, searching for the relationship between CV & Hp genotype and the risk for devel- opment of DCI; both variables failed to achieve a signifcant relationship for DCI (P > 0.05). Conclusion: The Hp genotype may determine the susceptibility to cerebral vasospasm after acute aSAH. This has the potential for use in risk stratifcation by allowing for the identifcation of those patients requiring intensive monitoring due to their inherent genetic risk for developing CV allowing for the promising selective application of aggressive treatments to those patients. 1. Introduction In a systematic review of population-based studies, the incidence of aneurysmal subarachnoid hemorrhage (aSAH) ranged from 2 to 16 per 100,000 population. Furthermore, the incidence rate of aSAH in low- to middle-income countries was found to be nearly double that of high- * Corresponding author at: Department of Neurology, Neuro-intervention Unit, Matareya Educational Hospital, Matareya, Cairo, 11719, Egypt. E-mail addresses: a_ateia@hotmail.com (A.M. Ateia), ahmedelbassiony@gmail.com (A. Elbassiouny), sobhyhassab2001@yahoo.com (S.H. El-Nabi), dr. nagiafahmy@med.asu.edu.eg (N.A. Fahmy), balkimy60@hotmail.com (M.H. Ibrahim), dr.garawani@yahoo.com (I. El-Garawani), khaledspain@yahoo.com (K.M. Geba), magdymassoud@hotmail.com (M. Khalaf). Contents lists available at ScienceDirect Clinical Neurology and Neurosurgery journal homepage: www.elsevier.com/locate/clineuro https://doi.org/10.1016/j.clineuro.2020.106296 Received 28 December 2019; Received in revised form 4 October 2020; Accepted 6 October 2020