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

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be comatose (with severe EBI) and who will recover (with less severe EBI) once the aneurysm is treated and sedation withdrawn.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.

Brain-Specific Biomarkers as Mortality Predictors after Aneurysmal Subarachnoid Haemorrhage

“…In a clinical study by Petzold et al, non-survivors maintained high levels of S100B for over 24 h, slowly decreased on day 2 and reached a plateau on days 3-6 [11]. Similarly, in a recent study by Balanca, a significant decline in S100B in the blood was noted on day 3 after an aSAH diagnosis [22]. The decrease in blood levels of S100B found in several studies suggests that there may be renal clearance into the urine.…”

“…The time course of blood–brain barrier disruption after SAH has not been fully investigated. The results of both experimental and clinical studies indicate that it is most useful to monitor the biomarkers of brain damage in the first 2–3 days after SAH [ 21 , 22 ]. In our study, the longitudinal profile of biomarkers was rather constant in both non-survivors and survivors over the 3 days of observation.…”

Narrative review of roles of astrocytes in subarachnoid hemorrhage

“…Besides GFAP, S100B is also a biomarker of reactive astrocytes, and the elevation of S100B expressions features the CNS pathologies as well. In SAH patients, the expression of GFAP and S100B levels upregulated in both cerebral spinal fluid (CSF) and serum, and higher S100B levels in CSF is associated with poor 1-year clinical outcome ( 57 ). In animal SAH models, GFAP and astrocytic S100B levels were also increased significantly.…”

DAMPs and RAGE Pathophysiology at the Acute Phase of Brain Injury: An Overview

“…However, they remain the gold standard to guide clinical decision. During this early phase of brain injury management, several applications of DAMPs as biomarkers have been investigated, such as early injury severity rating [ 78 ], distinguishing ischemic or hemorrhagic lesions [ 79 ], or prognostication of long-term outcome [ 80 ].…”

“…The most extensively studied biomarkers are those associated with damage to neurons (neuron-specific enolase, NSE) and glial cells (S100B and glial fibrillary acidic protein—GFAP, mainly expressed in astrocytes) [ 81 ]. S100B and GFAP allow the diagnosis of intracranial hemorrhage in patients with cerebral ischemia [ 78 , 79 , 80 , 82 , 83 , 84 , 85 , 86 , 87 , 88 ] ( Table 1 ). They are also accurate diagnostic biomarkers that facilitate the triage and the need for brain imaging within a few hours following mild and moderate TBI [ 89 , 90 , 91 ] ( Table 2 ).…”