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Please confirm that an ethics committee approval has been applied for or granted: Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submissionApplication for ESRA Abstract PrizesBackground and Aims Aneurysmal subarachnoid hemorrhage (aSAH) is a critical neurovascular emergency affecting 2–16 per 100,000 individuals annually, with women at a 1.24-fold higher risk than men. 1 Complications arise in approximately 40% of cases, often leading to significant morbidity. This study aimed to evaluate the prognostic role of preoperative NT-proBNP in predicting DCI, alongside Troponin T (Trop T) levels and ECG changes, in aSAH patients undergoing surgical intervention.Methods A prospective observational cohort study was conducted at PGIMER, enrolling 184 adult patients with angiographically confirmed aSAH undergoing clipping/coiling within 4 days of ictus after institutional ethics committee approval and CTRI registration. Patients with significant systemic illness were excluded. Pre-op NT-proBNP, Troponin T, and ECGs were obtained. DCI was defined clinically and radiologically. Data were analyzed using logistic regression and ROC curves.Results DCI occurred in 56 patients (30.4%). NT-proBNP levels were significantly higher in DCI patients (mean: 1091.05 pg/mL vs. 328.90 pg/mL, p<0.001). NT-proBNP correlated positively with severity scores (Hunt & Hess, WFNS, MFS). On multivariate analysis, NT-proBNP (OR 1.11 per 100 pg/mL, p<0.001), age (OR 1.07, p=0.004), smoking, and MFS were independent predictors of DCI. ECG abnormalities (e.g., T-wave inversion) were more frequent in the DCI group and associated with elevated NT-proBNP.Abstract P285 Figures 1 and 2Abstract P285 Tables 1 and 2Conclusions Preoperative NT-proBNP is a valuable predictor of DCI in aSAH, particularly due to its high negative predictive value. Trop T reflects disease severity, it does not independently predict DCI. Further multicentric research is warranted to explore the dynamic role of biomarkers in aSAH prognosis.