Early prognosis value of the first 24 hours mean plasma S100β protein level after subarachnoid aneurysmal hemorrhage

Introduction

Plasma S100β protein (PS100β) was described as a biological marker of white substance damage and brain ischemia. Studies of new neuroprotective approaches in patients with traumatic brain injury and subarachnoid aneurysmal hemorrhage would benefit from the development of such markers. The aim of this study was to evaluate the first 24 hours mean plasma PS100β for predicting outcome at ICU discharge after subarachnoid aneurysmal hemorrhage (SAH).

Methods

From August 2006 to August 2008, 100 patients (46 men and 54 women; mean age 52 ± 11 years) were admitted for SAH and treated by surgical clipping or coiling within 2 days after admission. SAPS II, World Federation of Neurological Surgeons (WFNS), Fisher and Glasgow Outcome Scale (GOS) were scored at ICU discharge. Plasma S100β concentrations were assayed at admission (hours 0, 6 and 24) and daily up to day 12 (routine procedure). Statistical analysis relied on the mean first 24 hours PS100β and the main outcome criterion was the GOS score at discharge dichotomized as poor (GOS 1 to 3) or good (GOS 4 to 5).

Results

Poor outcome was associated with high mean first 24 hours PS100β, high initial WFNS and Fisher scores in univariate analysis (P < 0.0001). The best cut-off for the mean first 24 hours S100β value was 0.15 μg/l (specificity 0.60, 95% confidence interval (CI) 0.52 to 0.67; sensitivity 0.85, 95% CI 0.79 to 0.89; area under the curve 0.83, 95% CI 0.69 to 0.92; Figure 1).

Figure 1

ROC curve of the first 24 hours mean PS100β value and outcome at ICU discharge.

Conclusions

The mean PS100β value assessed during the first 24 hours is a prognostic tool complementary to initial clinical evaluation in SAH patients.