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Master Thesis

Intérêt d'un dosage quotidien de la protéine s100b pour prédire la survenue d'une ischémie cérébrale retardée compliquée d’infarctus cérébral après une hémorragie sous-arachnoïdienne anévrismale

Abstract : Background and Purpose: Aneurysmal subarachnoid hemorrhage (aSAH) is a serious disease with high rate of mortality and morbidity, especially because of the occurrence of delayed cerebral ischemia (DCI) related with cerebral vasospasm or not. Protein S100b, a glial protein, is a wellknown biomarker of cerebral ischemia and high serum S100b level after aSAH is correlated with poor neurologic outcome. In this study, we aimed to relate variations of daily-assessed serum S100b level after aneurysm occlusion and occurrence of delayed cerebral ischemia (DCI) with cerebral infarction (CI). Methods: Patients successively admitted in a French neurointensive care unit between 2014 and 2017 for aSAH in whom serum S100b was assessed at least 5 consecutive days after systematic post aneurysm occlusion CT-scan were enrolled in this retrospective study. The occurrence of DCI with CI was recorded on a CT-scan or MRI performed 4 to 6 weeks after aSAH by a senior radiologist blinded to patient’s history, comparatively with the systematic CT-scan performed 24 to 72 hours after aneurysm occlusion, according to standard definition. Results: 78 patients were enrolled in the study, DCI occurred in 21 patients (27%). Whatever the delay, a 100% positive variation from basal value (S100b assessed on the day of systematic CT-scan post-aneurysmal occlusion) predicted occurrence of DCI with CI (Sensitivity 48%, Specificity 79%). In multivariable analysis, these results stayed significative with adjustment on delay of 100% variation occurrence, on SAPSII, and on main therapies of vasospasm (HTA-therapy, Milrinone, angioplasty). A sensitivity analysis was performed and showed that any increase of S100b from basal value predicted occurrence of DCI with CI (Sensitivity 81%, Specificity 49). Conclusion : Daily serum S100b monitoring could be helpful to detect DCI with cerebral infarction after subarachnoid aneurysmal hemorrhage. More studies, in particular prospective studies are necessary to confirm the interest of S100b use in everyday clinical practice, and how a management based on S100b variations could reduce occurrence of cerebral infarction and improve outcome.
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Submitted on : Friday, June 28, 2019 - 2:35:20 PM
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Lucie Aupetitgendre. Intérêt d'un dosage quotidien de la protéine s100b pour prédire la survenue d'une ischémie cérébrale retardée compliquée d’infarctus cérébral après une hémorragie sous-arachnoïdienne anévrismale. Life Sciences [q-bio]. 2019. ⟨dumas-02168168⟩

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