Abstract
BackgroundProtein S100β (PS100 β) and neuron specific enolase (NSE) have been described as biological markers of neuronal damage. The purpose of our study was to assess the prognosis thresholds of these biomarkers in subarachnoid aneurysmal hemorrhage (SAH).MethodsForty eight patients admitted following SAH were treated by endovascular coiling. Initial neurologic severity was assessed using the World Federation Neurologic Surgeons (WFNS), Fisher grades, initial Glasgow coma scale (GCS) and SAPS II. PS100β and NSE plasma concentration were measured daily within the first week. The primary endpoint of the study was the 6-month Glasgow Outcome Score (GOS) dichotomized as poor (GOS 1–3) or good (GOS 4–5).ResultsA poor outcome at 6-months was associated with significant higher levels of S100β value from day 1 to day 7, whereas NSE values were significantly higher from day 5 to day 7. Best threshold value, for prognosis, was obtained at day 5 for PS100β >0.13 μg/L (specificity 0.95 95 % confidence interval (CI) 0.74–1; sensitivity 0.83 95 % CI 0.65–0.93) and day 7 for NSE >14.5 μg/L (specificity 0.90 95 % CI 0.67–0.98); sensitivity (0.69 95 % CI 0.51–0.83)). After multivariate logistic analysis, only PS100β at day 5 and SAPS II enabled to predict neurological outcome at 6 months (p <0.05).ConclusionPS100β >0.13 μg/L at day 5 is an independent predicting factor of poor neurological outcome at 6 months following SAH. This result could support the use of this biomarker at the acute phase of SAH to help physician determine the prognosis.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1200-1) contains supplementary material, which is available to authorized users.
Highlights
Protein Protein S 100 β (S100β) (PS100 β) and neuron specific enolase (NSE) have been described as biological markers of neuronal damage
Characteristics of patients and comparison according to severity at 6 months A total of 58 patients were consecutively enrolled in the study
The major findings of this prospective study are summarized as follows: 1) both PS100β and NSE serum concentrations were higher in patients with poor prognosis than in those with good prognosis; 2) PS100β and NSE values did not normalize in patients with poor prognosis; and 3) a normal PS100β plasma concentration at day 5 after subarachnoid aneurysmal hemorrhage (SAH) and a low SAPS Simplified acute physiology score (II) were strongly and independently associated with a good neurological outcome at 6 months
Summary
Protein S100β (PS100 β) and neuron specific enolase (NSE) have been described as biological markers of neuronal damage. Subarachnoid aneurysmal hemorrhage (SAH) has a 30-day mortality rate of 45 % with approximately half of the survivors sustaining irreversible brain damage [1]. It is a real public health problem and early identification and quantification of cerebral damage after injury can be challenging. The initial imaging Fisher score or modified Fisher scale [4] is usually obtained in clinical practice. This classification has been proposed to assess the risk of vasospasm after SAH but not direct assessment of prognosis.
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