gms | German Medical Science

Objective: Prediction of patient outcome after subarachnoid hemorrhage (SAH) at early time points is difficult. The objective of the present study was to evaluate if early S 100 CSF values might be an independent prognostic factor for patient outcome which is independent from occurrence of vasospasm.

Methods: Patients with SAH submitted to our ICU were included in the study irrespective of endovascular or surgical aneurysm treatment or outcome. Exclusion criteria were age <18 years and implantation of a ventricular drainage later than 3 days after sah. CSF was taken daily and S100 measured at our laboratory using an electrochemiluminescent assay. Outcome was evaluated at hospital discharge and 6 weeks after, using the Glascow Outcome Scale. Patients were divided in GOS 1-3 representing poor and GOS 4-5 good outcome. Initial S100 levels were correlated to the outcome groups using a chi-square test. To rule out influence of vasospasm on the S100 levels a second chi-square test was performed.

Results: 15 patients were included in the study, 8 in the good, 7 in the poor outcome group. Initial S100 levels showed a wide range between 1,9 and >600 µg/l and dropped significantly during the following days. S100 levels were clearly correlated to patient outcome, with a cutoff at 50 µg/l. Patients with initial S100 levels below 50 µg/l were in the GOS 4-5, except 1 patient who was GOS 3 due to a complication during coiling. Patients with S100 values >50 µg/l had poor outcome or died. Sensitivity was 0.86, specificity 1.0. The second chi-square showed no influence of vasospasm on these results since vasospasm was equally distributed in both patient groups.

Conclusions: Out data clearly show a significant correlation between the early S100 values in CSF and outcome of patients after sah. Patients with low initial S100 values had good outcome despite the appearance of vasospasm at hospital discharge whereas patients with initial S100 levels > 50 µg/l were either dead or in the poor outcome group. The predictive value showed high sensitivity and specificity and was independent from occurrence of vasospasm. In combination with other factors such as age or WFNS grade, S100 might be a helpful tool for the treatment of those patients. Especially in patients with signs of vasospasm in transcranial Doppler without neurological signs or when patients are intubated, elevated S100 levels (>50 µg/l) might be the prognostic factor leading to a more aggressive treatment.