gms | German Medical Science

Objective: Prediction of outcome after subarachnoid hemorrhage (SAH) at early time points is difficult. It is also still under discussion if the initial trama due to the SAH or later events such as vasospasm are finally responsible for the patient outcome. S-100 can be used as a marker for brain trauma. The objective of the present study was to evaluate if early S 100 CSF values might be an independent prognostic factor for patient outcome and could be used as a biomarker for patient outcome after SAH.

Method: Patients with SAH submitted to our ICU were included in the study irrespective of endovascular or surgical aneurysm treatment if vetricular drainage was inserted < 48 h after sah. CSF was sent to the lab and S 100 was measured using an electrochemiluminescent assay. Outcome was evaluated at hospital discharge using the Glascow Outcome Scale. Patients were divided in GOS 1-3 representing poor and GOS 4-5 representing good outcome. S100 levels were correlated to the outcome. Sensitivity and specificity was then calculated.

Results: 80 patients were included in the study, 32 patients had GOS values 4-5 and 48 GOS 1-3 at hospital discharge. Initial S100 levels showed a wide range between 1,9 and >600 µg/l. S100 levels were clearly correlated to patient outcome, with a cutoff at 50 µg/l. Most patients with initial S100 levels below 50 µg/l were in the GOS 4-5, except 4 patients. Patients with S100 values >50 µg/l had poor outcome or died. Sensitivity was 0.86, specificity 73%. Vasospasm was equally distributed in both patient groups.

Conclusions: Our data clearly show a significant correlation between early S100 values and outcome 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 mostly either dead or in the poor outcome group. The sensitivity of 86% and specificity of 73 % and the independence from occurrence of vasospasm support the use of S-100 in CSF as a biomarker for outcome after SAH and the importance of the initial trauma caused by the sah for patient outcome. 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.