Prognostic value of early S100B protein and Neuron-specific Enolase in patients with poor grade aneurysmal subarachnoid hemorrhage, a pilot study
- Hamburg Center of Neuroscience (HCNS)
- Journal Article
- AG Klinische Studien (142)
BACKGROUND: This prospective study was undertaken to investigate the value of early S100b protein (S100) and neuron-specific enolase (NSE) in prognosticating outcome in patients with poor grade aneurysmal subarachnoid hemorrhage (SAH) and to develop a statistical model and cut-off values for clinical practice.
METHODS: Between 2012 and 2014, patients with poor grade SAH (Hunt & Hess grade 3-5) who were admitted within 24 hours after hemorrhage were prospectively enrolled in the study. Serum NSE and S100 levels were assayed once daily during the first 3 days after hemorrhage. Patient characteristics, Glasgow Coma Scale, Hunt & Hess and Fisher grade at admission were recorded. Glasgow outcome scale (GOS) was obtained at 6 months and dichotomized as poor (GOS 1-3) or good (GOS 4-5). Logistic regression and receiver operating characteristic curve were used to assess the value of S100 and NSE in predicting outcome and cut-off values were calculated using conditional interference trees.
RESULTS: 52 patients were included in the study. Hunt & Hess grading was 3 in 23 patients, 4 in 15 patients and 5 in 14 patients. S100 ranged from 0.07 to 5.62μg/l, mean 0.87±1.06μg/l. NSE range was 5.7 to 94.2μg/l and mean 16.1±10.5μg/l. At 6 months follow up, 23 patients (44.2%) had poor outcome and 29 patients (55.8%) showed good outcome. Both S100 at day one (p=0.004, cut-off 0.202μg/l) and NSE at day one (p=0.047, cut-off 9.4μg/l) predicted good outcome with a specificity of 100%. The specificity of mean S100 in detecting patients with poor outcome reached 100% (p=0.003) when combined with mean NSE levels.
CONCLUSION: S100 and NSE measured during the first 3 days after hemorrhage showed separately and combined a significant predictive value in prognosticating clinical outcome in patients with poor grade SAH. A multicenter study with large patient cohort is necessary to validate the above mentioned cut-off values for clinical practice.
- Forschungsinformationssystem des UKE