Significance and Diagnostic Accuracy of Early S100B Serum Concentration after Aneurysmal Subarachnoid Hemorrhage.

Baptiste Balança,Thomas Ritzenthaler,Frédéric Dailler,Carole Bodonian,Florent Gobert,Anne Terrier,Caroline Richet,Laurent Desmurs,Romain Carrillon,Armand Perret-Liaudet

doi:10.3390/jcm9061746

Abstract

Background: Early brain injuries (EBI) are one of the most important causes of morbidity and mortality after subarachnoid hemorrhage. At admission, a third of patients are unconscious (spontaneously or sedated) and EBI consequences are not evaluable. To date, it is unclear who will still be comatose (with severe EBI) and who will recover (with less severe EBI) once the aneurysm is treated and sedation withdrawn. The objective of the present study was to determine the diagnostic accuracy of S100B levels at hospital admission to identify patients with severe neurological consequences of EBI. Methods: Patients were consecutively included in this prospective blinded observational study. A motor component of the Glasgow coma score under 6 on day 3 was used to define patients with severe neurological consequences of EBI. Results: A total of 81 patients were included: 25 patients were unconscious at admission, 68 were treated by coiling. On day 3, 12 patients had severe consequences of EBI. A maximal S100B value between admission and day 1 had an area under the receiver operating characteristic curve (AUC) of 86.7% to predict severe EBI consequences. In patients with impaired consciousness at admission, the AUC was 88.2%. Conclusion: Early S100B seems to have a good diagnostic value to predict severe EBI. Before claiming the usefulness of S100B as a surrogate marker of EBI severity to start earlier multimodal monitoring, these results must be confirmed in an independent validation cohort.

Highlights

The 28-day mortality associated with subarachnoid hemorrhage (SAH) is reported to range from 26% to 40% in Europe [1] and half of those who survive sustain irreversible brain damage [2]
Physicians usually rate Early brain injuries (EBI) at two critical moments: at the first physician contact using the World Federation of Neurosurgical Surgeons (WFNS) grading scale, which is a good predictor of clinical outcome [8]; and 3 days later, once the aneurysm is secured, potential hydrocephalus is treated, anesthesia is withdrawn, and before the period during which delayed cerebral ischemia (DCI) can occur, as the latter impacts prognosis [9,10]
We explored early S100B diagnostic accuracy to predict the outcome at intensive care unit (ICU) discharge

Summary

Introduction

The 28-day mortality associated with subarachnoid hemorrhage (SAH) is reported to range from 26% to 40% in Europe [1] and half of those who survive sustain irreversible brain damage [2] Bleeding consequences, such as cerebral edema, intracerebral hemorrhage, mechanical stress, or raised intracranial pressure, as well as re-bleeding or aneurysm treatment complications, are important determinants of poor outcome [3,4,5,6,7]. These first brain insults have been grouped together and termed early brain injuries (EBI). Before claiming the usefulness of S100B as a surrogate marker of EBI severity to start earlier multimodal monitoring, these results must be confirmed in an independent validation cohort

Objectives

Methods

Results

Discussion

Conclusion