S100B and brain natriuretic peptide predict functional neurological outcome after intracerebral haemorrhage

Abstract

Objective: To determine the predictive value of S100b and brain natriuretic peptide (BNP) in order to determine accurately and quickly a discharge prognosis after primary supratentorial intracerebral haemorrhage (ICH).

Methods: After IRB approval and informed consent, blood samples were obtained and analysed from 28 adult patients consecutively admitted to the neuroscience intensive care unit with computed tomography-proven supratentorial ICH from June 2003 and December 2004 within the first 24 h after symptom onset for S100b and BNP. Functional outcomes on discharge were dichotomized to favourable (mRS < 3) or unfavourable.

Results: BNP (a neurohormone) and S100b (a marker of glial activation) were found to be independently highly predictive of functional neurological outcome at the time of discharge as measured by the modified Rankin Score (BNP: p < 0.01, r = 0.46; S100b: p < 0.01, r = 0.42) and the Barthel Index (BNP: p < 0.01, r = 0.54; s100b: p < 0.01, r = 0.50). Although inclusion of either biomarker produced additive value when included with traditional clinical prognostic variables, such as the ICH score (Barthel index: p < 0.01, r = 0.66; mRS: p < 0.01, r = 0.96), little predictive power is added with inclusion of both biomarkers in a regression model for neurological outcome.

Conclusions: Serum S100b and BNP levels in the first 24 h after injury accurately predict neurological function at discharge after supratentorial ICH.

Keywords::

• Intracerebral haemorrhage
• prognosis
• s100 proteins
• brain natriuretic peptide
• intensive care
• neurological outcome

Acknowledgements

Funding for this study was provided by NIH T32 GM08600-01 (MLJ). Additionally, Biosite, Inc. provided sample analysis for S100B and BNP. Finally, we would like to acknowledge the assistance of the Duke University Hospital Neuroscience Intensive Care faculty and staff in continuing efforts to support clinical research and provide excellent patient care on a daily basis.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.