Department of Neurology, University Hospital Zurich, Zurich, Switzerland.
Department of Neurology, Inselspital University of Berne, Switzerland.
Eur Stroke J. 2023 Mar;8(1):309-319. doi: 10.1177/23969873221145391. Epub 2022 Dec 21.
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.
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.
Forty six patients (2.6%) developed symptomatic intracranial hemorrhage and 90 patients (5.2%) developed symptomatic brain edema. After adjustment for established risk factors, logS-100B levels remained independently associated with both symptomatic intracranial hemorrhage (OR 3.41, 95% CI 1.7-6.9, = 0.001) and symptomatic brain edema (OR 4.08, 95% CI 2.3-7.1, < 0.001) in multivariable logistic regression models. Adding S-100B to the clinical prediction model increased the AUC from 0.72 to 0.75 ( = 0.001) for symptomatic intracranial hemorrhage and from 0.78 to 0.81 ( < 0.0001) for symptomatic brain edema.
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.
早期识别急性缺血性卒中后出现症状性颅内出血和症状性脑水肿的患者对于临床决策至关重要。星形胶质细胞蛋白 S-100B 是血脑屏障破坏的标志物，在颅内出血和脑水肿的形成中起着重要作用。在这项研究中，我们评估了血清 S-100B 对这些并发症发展的预后价值。
在前瞻性、观察性、多中心 BIOSIGNAL 队列研究中，对 1749 例连续急性缺血性卒中患者在发病后 24 小时内测量血清 S-100B 水平（平均年龄 72.0 岁，58.3%为男性）。为了确定症状性颅内出血或症状性脑水肿，对所有接受再灌注治疗或 NIHSS 增加 ⩾4 分的患者进行随访神经影像学检查。
46 例（2.6%）患者发生症状性颅内出血，90 例（5.2%）患者发生症状性脑水肿。在校正了已建立的危险因素后，logS-100B 水平与症状性颅内出血（OR 3.41，95%CI 1.7-6.9，=0.001）和症状性脑水肿（OR 4.08，95%CI 2.3-7.1，<0.001）均独立相关，多变量逻辑回归模型。将 S-100B 添加到临床预测模型中，使症状性颅内出血的 AUC 从 0.72 增加到 0.75（=0.001），症状性脑水肿的 AUC 从 0.78 增加到 0.81（<0.0001）。
发病后 24 小时内测量的血清 S-100B 水平与急性缺血性卒中患者症状性颅内出血和症状性脑水肿的发展独立相关。因此，S-100B 可能有助于早期对卒中并发症进行风险分层。
