Serum S-100B adds incremental value for the prediction of symptomatic intracranial hemorrhage and brain edema after acute ischemic stroke. (March 2023)

• Record Type: Journal Article
• Authors: Honegger, Tim; Schweizer, Juliane; Bicvic, Antonela; Westphal, Laura P; Schütz, Valerie; Inauen, Corinne; Pokorny, Thomas; Bracher, Katja; Arnold, Marcel; Fischer, Urs; Bonati, Leo H; De Marchis, Gian Marco; Nedeltchev, Krassen; Kahles, Timo; Cereda, Carlo; Kägi, Georg; Montaner, Joan; Bustamante, Alejandro; Palà, Elena; Ntaios, George; Foerch, Christian; Luft, Andreas; Spanaus, Katharina; Saleh, Lanja; von Eckardstein, Arnold; Arnold, Markus; Katan, Mira
• Is Part Of: European stroke journal. Volume 8:Number 1(2023)
• Page Start: 309
• Page End: 319
• Publication Date: 2023-03
• Subjects: S-100B -- stroke complications -- intracranial hemorrhage -- brain edema -- ischemic stroke -- serum biomarker; Cerebrovascular disease -- Periodicals; 616.8005
• DOI: 10.1177/23969873221145391
• Languages: English
• ISSNs: 2396-9873

Abstract

Background: Early identification of patients developing symptomatic intracranial hemorrhage and symptomatic brain edema after acute ischemic stroke is essential for clinical decision-making. Astroglial protein S-100B is a marker of blood-brain barrier disruption, which plays an important role in the formation of intracranial hemorrhage and brain edema. In this study, we assessed the prognostic value of serum S-100B for the development of these complications. Methods: Serum S-100B levels were measured within 24 h from symptom onset in 1749 consecutive acute ischemic stroke patients from the prospective, observational, multicenter BIOSIGNAL cohort study (mean age 72.0 years, 58.3% male). To determine symptomatic intracranial hemorrhage or symptomatic brain edema, follow-up neuroimaging was performed in all patients receiving reperfusion therapy or experiencing clinical worsening with an NIHSS increase of ⩾4. Results: Forty six patients (2.6%) developed symptomatic intracranial hemorrhage and 90 patients (5.2%) developed symptomatic brain edema. After adjustment for established risk factors, log10 S-100B levels remained independently associated with both symptomatic intracranial hemorrhage (OR 3.41, 95% CI 1.7–6.9, p = 0.001) and symptomatic brain edema (OR 4.08, 95% CI 2.3–7.1, p < 0.001) in multivariable logistic regression models. Adding S-100B to the clinical prediction model increased the AUC from 0.72 to 0.75 ( p = 0.001) for symptomatic intracranial hemorrhage and from 0.78 to 0.81 ( p < 0.0001) for symptomatic brain edema. Conclusions: Serum S-100B levels measured within 24 h after symptom onset are independently associated with the development of symptomatic intracranial hemorrhage and symptomatic brain edema in acute ischemic stroke patients. Thus, S-100B may be useful for early risk-stratification regarding stroke complications.