Originally published by 2 Minute Medicine^® (view original article). Reused on AccessMedicine with permission.

1. S100β levels 24 hours after IVT were independently associated with HT, infarct volume, and prognosis in stroke patients

Evidence Rating Level: 2 (Good)

Intravenous thrombolysis (IVT) is the treatment with the highest level of evidence in acute disabling ischemic stroke however half of these patients do not reach favourable outcomes. S100β is a calcium-binding protein mostly seen in astrocytes meaning an elevation in serum concentrations reflets astrocyte damage. Previous studies have shown that S100β levels in the peripheral blood 48 hours post-stroke was functionally significant at 3 months. Thrombolytic drugs may play a role in elevating S100β as they increase the breakdown of the blood-brain barrier which allows more S100β to enter systemic circulation. This prospective cohort study aimed to look at S100β levels in patients 24 hours after IVT and look for the relationship between S100β and hemorrhagic transformation (HT) and final infarct volume. 1072 blood samples were analyzed. Patients who underwent HT had significantly higher serum S100β levels 24 hours post-IVT (0.237 (0.100–0.801) ng/mL vs. 0.118 (0.050–0.240) ng/mL, P < 0.001). No significant interaction association was found between stroke lateralization and S100β. When looking at infarct volume, the highest S100β levels were independently corelated with larger infarct volumes. The association of infarct volume and S100β levels were similar between dominant and non-dominant hemisphere stroke showing no increased incidence in either outcome. Functionally, higher S100β was associated with higher 24-h and 7-day National Institutes of Health Stroke Scale (NIHSS) scores. Patients with dominant hemisphere strokes and high S100β had higher NIHSS scores. S100β was also significantly elevated in patients with unfavourable outcomes on the modified Rankin Scale (mRS) score (0.140 (0.062–0.393) ng/mL vs. 0.100 (0.050–0.196) ng/mL, P < 0.001). Finally, the highest S100β level was independently predictive of all-cause death within 3 months of IVT. Therefore, S100β levels 24 hours after IVT were independently associated with HT, infarct volume, and prognosis in stroke patients.

Click to read the study in BMC Medicine

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