Der prädiktive und diagnostische Wert des kontinuierlichen Monitorings von S100 bei aneurysmatischer Subarachnoidalblutung

Aneurysmal subarachnoid hemorrhage (SAH) is a severe neurological condition with high mortality and morbidity. Vasospasm and delayed ischemic neurological deficits (DIND) are major complications affecting patient outcomes. Reliable biomarkers for early detection and management of ischemia remain lacking. S100, a protein associated with astrocytic damage and blood-brain barrier disruption, has shown potential as a predictive and monitoring tool.

This retrospective study included 100 SAH patients admitted to a neurosurgical intensive care unit. Daily S100 serum levels were measured from admission until discharge, and their trends were correlated with angiographic vasospasm, infarction, and neurological outcomes. Clinical data, including Hunt and Hess scores, modified Fisher scores, and imaging findings, were analyzed. S100 thresholds for predicting ischemia and outcome were evaluated using ROC analysis.

: Elevated S100 levels showed two distinct peaks: an initial rise post-hemorrhage and a secondary elevation linked to vasospasm-related ischemia, starting on day 7 and peaking by day 10. A threshold of 0.12 μg/L on the day of vasospasm showed 92% specificity and a positive predictive value of 94% for ischemic injury, while 0.17 μg/L had 100% specificity. Patients with infarction had significantly elevated S100 levels compared to those without infarction (mean levels of 0.13 μg/L vs. 0.08 μg/L, p<0.05). Mortality was observed in 20% of patients. Patients with poor outcome consistently exhibited higher S100 levels, particularly in the first five days after vasospasm detection. Higher S100 levels were also associated with the need for more invasive interventions, including ventriculoperitoneal shunting (28%), external ventricular drainage (71%), and decompressive hemicraniectomy (4%).

Continuous S100 monitoring provides valuable predictive and diagnostic insights into vasospasm-related ischemia in SAH patients. Elevated S100 levels correlate with infarction, clinical severity, and poor outcome.