Baptiste Balança1,2,3, Thomas Ritzenthaler1, Florent Gobert1, Caroline Richet4, Carole Bodonian1, Romain Carrillon1, Anne Terrier1, Laurent Desmurs4, Armand Perret-Liaudet4,5, Frédéric Dailler1. 1. Hospices Civils de Lyon, Hôpital Pierre Wertheimer, Department of Neurological Anesthesiology and Intensive Care Medicine, 69500 Lyon, France. 2. Inserm U1028, CNRS UMR 5292, Lyon Neuroscience Research Centre, Team TIGER, 69500 Lyon, France. 3. Université Claude Bernard Lyon 1, Centre Lyonnais d'Enseignement par la Simulation en Santé, SAMSEI, 69008 Lyon, France. 4. Hospices Civils de Lyon, Hôpital Pierre Wertheimer, Clinical Chemistry and Molecular Biology Laboratory, 69500 Lyon, France. 5. Inserm U1028, CNRS UMR 5292, Lyon Neuroscience Research Centre, Team BIORAN, 69500 Lyon, France.
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be comatose (with severe EBI) and who will recover (with less severe EBI) once the aneurysm is treated and sedation withdrawn.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.
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.