The association between serum S100β levels and prognosis in acute stroke patients after intravenous thrombolysis: a multicenter prospective cohort study

Abstract

Background: S100β is a biomarker of astroglial damage, the level of which is significantly increased following brain injury. However, the characteristics of S100β and its association with prognosis in patients with acute ischemic stroke following intravenous thrombolysis (IVT) remain unclear.

Methods: Patients in this multicenter prospective cohort study were prospectively and consecutively recruited from 16 centers. Serum S100β levels were measured 24 h after IVT. National Institutes of Health Stroke Scale (NIHSS) and hemorrhagic transformation (HT) were measured simultaneously. NIHSS at 7 days after stroke, final infarct volume, and modified Rankin Scale (mRS) scores at 90 days were also collected. An mRS score ≥ 2 at 90 days was defined as an unfavorable outcome.

Results: A total of 1072 patients were included in the analysis. The highest S100β levels (> 0.20 ng/mL) correlated independently with HT and higher NIHSS at 24 h, higher NIHSS at 7 days, larger final infarct volume, and unfavorable outcome at 3 months. The patients were divided into two groups based on dominant and non-dominant stroke hemispheres. The highest S100β level was similarly associated with the infarct volume in patients with stroke in either hemisphere (dominant: β 36.853, 95% confidence interval (CI) 22.659-51.048, P < 0.001; non-dominant: β 23.645, 95% CI 10.774-36.516, P = 0.007). However, serum S100β levels at 24 h were more strongly associated with NIHSS scores at 24 h and 3-month unfavorable outcome in patients with dominant hemisphere stroke (NIHSS: β 3.470, 95% CI 2.392-4.548, P < 0.001; 3-month outcome: odds ratio (OR) 5.436, 95% CI 2.936-10.064, P < 0.001) than in those with non-dominant hemisphere stroke (NIHSS: β 0.326, 95% CI - 0.735-1.387, P = 0.547; 3-month outcome: OR 0.882, 95% CI 0.538-1.445, P = 0.619). The association of S100β levels and HT was not significant in either stroke lateralization group.

Conclusions: Serum S100β levels 24 h after IVT were independently associated with HT, infarct volume, and prognosis in patients with IVT, which suggests the application value of serum S100β in judging the degree of disease and predicting prognosis.

Keywords: Acute ischemic stroke; Astroglial injury; Intravenous thrombolysis; Outcome; S100β.

Fig. 1

Geographical distribution of the hospitals

Fig. 2

Distribution of A final infarct volume, B NIHSS at 24 h, and C functional outcome assessed by mRS at 90 days according to S100β tertiles in the total cohort and patients with dominant and non-dominant hemisphere stroke. Abbreviations: NIHSS, National Institutes of Health Stroke Scale; mRS, modified Rankin Scale

Fig. 3

Association between S100β tertiles and unfavorable outcome at 90 days according to different models of A all patients, B patients with dominant hemisphere stroke, and C patients with non-dominant hemisphere stroke. Notes: Model 1 was unadjusted; Model 2 was adjusted for age and sex; Model 3 was adjusted for age, sex and vascular risk factors (including cigarette smoking, alcohol consumption, hypertension, diabetes mellitus, dyslipidemia, hyperhomocysteinemia, previous ischemic stroke and coronary heart disease); Model 4 was adjusted for age, sex, vascular risk factors and clinical data (including SBP, DBP, HR, blood glucose, admission NIHSS, onset-to-alteplase bolus time, TOAST, infarct location, and bridging therapy). Abbreviations: SBP, systolic blood pressure; DBP, diastolic blood pressure; HR, heart rate; NIHSS, National Institutes of Health Stroke Scale; TOAST, Trial of Org 10,172 in Acute Stroke Treatment classification