S-100B Levels in Stroke Patients

Abstract

Background: Serum S100B is found in the glial cells and is elevated with stroke. It can be used in the diagnostic and prognostic utility. However, the use of S100B in the emergency room is controversial. In our study, we wish to determine if the National Institutes of Health Stroke Scale (NIHSS) and Glasgow Coma Scale (GCS) have utility in predicting the acute and first month poststroke mortality and morbidity in emergency room patients, as measured by serum S100B and clinical evaluations. Methods: A total of 62 consecutive patients who applied to the emergency service with acute ischemic stroke were enrolled in the study. Following a detailed neurological examination, GCS and NIHSS were used to determine the consciousness of the patients. Their serum samples were obtained as soon as they arrived into the emergency service and at the time of discharge. As outcome variables, the scores on the modified Rankin Disability Scale (mRDS) at 1 month were determined. Results: The S100B level immediately after the stroke was significantly related to the NIHSS and GCS scores. In addition, the clinical state and S100B levels of patients varied with the length of time between the stroke onset and emergency room treatment. Nine patients (14.5%) died while in the hospital. The stepwise Logistic regression analysis showed that NIHSS was an independent predictor of mortality (odds ratio = 1.48; 95% confidence interval, 1.01-2.18; P≤0.05). Thirty days poststroke, the mRDS levels significantly correlated with the initial and later S100B levels and GCS and NIHSS scores. The linear Logistic regression analysis indicated that NIHSS score and age were independent risk factors of mRDS (odds ratio= 1.48; 95% confidence interval, 1.01-2.18; P≤0.05) in our study population. Conclusions: The NIHSS scale is a much more reliable method to determine mortality and morbidity and also adds no extra cost. Therefore, it is not recommended to measure S100B in the emergency room, but if it is measured, then the time between measurement and onset of stroke symptoms should be determined.