Serum S100B and Clinical Outcomes After Spontaneous Subarachnoid Hemorrhage: A Prospective Observational Study

Q: What are the key findings of this study?

Higher log-transformed early serum S100B levels measured 24 hours post-admission were independently associated with increased odds of an unfavorable functional outcome at 14 days (adjusted OR 3.40).

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Spontaneous subarachnoid hemorrhage (n=108). Intervention: Elevated early serum S100B levels vs. Lower serum S100B levels. Primary outcome: Unfavorable functional outcome (mRS 3-6) at 14 days associated with 24-hour log-transformed S100B (T0) (adjusted OR 3.40, 95% CI 1.80-6.43, p=<0.001).

Q: What does this research mean for the field?

Higher early serum S100B levels measured within 24 hours post-admission are independently associated with increased odds of unfavorable functional outcome and mortality in patients with spontaneous subarachnoid hemorrhage. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To investigate the prognostic utility of serum S100B levels measured at early intervals for predicting functional outcomes, mortality, and complications in patients with spontaneous subarachnoid hemorrhage.

Annamaria Auricchio; Silvia Baroni; Michele Nichelatti; Giulia Napoli; Francesco Calvanese; Giovanni Maria Ceccarelli; Renata Martinelli; Grazia Menna; Marco Obersnel; Luca Scarcia; Andrea Alexandre; Anselmo Caricato; Carmelo Lucio Sturiale; Alessio Albanese; Francesco Doglietto; Andrea Urbani; Alessandro Olivi; Giuseppe Maria Della Pepa

doi:10.1007/s12035-026-06202-2

Key result

Higher early serum S100B is linked to ~3.4-fold higher odds of unfavorable 14-day functional outcomes.

adjusted OR 3.40
95% CI 1.80-6.43
P<0.001
n=108

Why the study?

The prognostic value of serum S100B protein for mortality and functional outcomes after spontaneous subarachnoid hemorrhage was not well established.

Key Points

To investigate the prognostic utility of serum S100B levels measured at early intervals for predicting functional outcomes, mortality, and complications in patients with spontaneous subarachnoid hemorrhage.
Conducted a prospective observational study of 108 consecutive patients with spontaneous subarachnoid hemorrhage admitted between January 2022 and August 2024.
Measured serum S100B at 24 h (T0), 72 h (T1), and 7 days (T2) post-admission.
Evaluated functional outcomes via the modified Rankin Scale at 14 days and 3 months, alongside delayed cerebral ischemia and systemic complications using multivariable logistic regression and random forest models.
Higher log-transformed S100B at 24 h independently predicted unfavorable functional outcome (mRS 3–6) at 14 days (adjusted OR 3.40, 95% CI 1.80–6.43, p < 0.001) and 3 months (adjusted OR 4.43, 95% CI 2.08–9.47, p < 0.001), as well as increased mortality (adjusted OR 3.59, 95% CI 1.53–8.46, p = 0.003).
In landmark analyses at 72 h (N=101), S100B remained independently associated with 3-month poor functional outcome (adjusted OR 4.28, 95% CI 2.00–9.17, p < 0.001) and subsequent death (adjusted OR 3.76, 95% CI 1.33–10.67, p = 0.013).
S100B at 72 h was associated with delayed cerebral ischemia in univariable analysis (OR 1.60, 95% CI 1.06–2.41, p = 0.026), but not after multivariable adjustment (adjusted OR 1.07, 95% CI 0.68–1.70, p = 0.765), and showed no significant association with systemic complications.

Study Design

Type

Observational (n=108)

Multicenter

No

Structured PICO

P

Population

108 adult patients with spontaneous subarachnoid hemorrhage, monitored for early brain injury severity and followed for 3 months to assess functional outcomes.

E

Exposure

Measurement of early serum S100B biomarker levels at 24 hours (T0), 72 hours (T1), and 7 days (T2) post-admission

O

Outcome

Functional outcome measured by the modified Rankin Scale (mRS) dichotomized as favorable (0-2) or unfavorable (3-6), and mortality at 14 days and 3 monthshard clinical

Main Result

Odds Ratio: 3.4 (95% CI 1.8–6.43)

p-value: p=<0.001

Early serum S100B levels reflect the severity of initial brain injury and serve as an independent prognostic biomarker for predicting 3-month functional outcome and mortality in patients with spontaneous subarachnoid hemorrhage.

Limitations

Relatively limited sample size
Single-center design restricts generalizability
Biomarker measurements limited to the first 7 days
Variability in the interval between ictus and hospital admission
Absence of long-term follow-up beyond 3 months
Potential for survivor-selection bias due to early mortality in T1 measurements
Relatively limited sample size may reduce statistical power and restrict generalizability
Analysis limited to biomarker measurements within the first 7 days, preventing evaluation of longer-term dynamics
Timing of biomarker assessment was referenced to hospital admission rather than the exact time of hemorrhage
Heterogeneity in clinical presentation, hemorrhage severity, and treatment strategies may have introduced residual confounding
Inclusion of non-aneurysmal sSAH cases represents a potential confounding factor
Exclusion of early deaths created survivor-selection bias for the 72-hour T1 landmark analysis

Implication

Early S100B was associated with unfavorable SAH outcomes; hypothesis-generating for prognostication and requires prospective validation before clinical use.

Abstract

This study aims to investigate the prognostic value of serum S100B protein in patients with spontaneous subarachnoid hemorrhage (sSAH), specifically in predicting mortality and functional outcomes. A prospective observational study was conducted on 108 consecutive sSAH patients admitted between January 2022 and August 2024. Serum S100B levels were measured at 24 h (T0), 72 h (T1), and 7 days (T2) post-admission. Clinical outcomes, including the modified Rankin Scale (mRS) at 14 days and 3 months, as well as complications such as delayed cerebral ischemia (DCI) and systemic adverse events, were recorded. Associations were analyzed using logistic regression and explored using random forest with repeated cross-validation. Higher early S100B levels were independently associated with worse functional outcome and higher mortality. S100B at T1 was associated with delayed cerebral ischemia (DCI) in univariate analysis, but this association did not persist after multivariable adjustment for clinical severity. Random forest analyses supported the prognostic value of early S100B measurements for functional outcome; S100B at T0 and T1 emerged as the most influential predictors. No significant association was found between S100B levels and systemic complications. S100B is a promising early biomarker for predicting mortality and functional outcomes in sSAH, whereas its independent association with DCI and its predictive value for systemic complications appear limited. Larger validation studies are warranted before biomarker-guided clinical protocols can be considered.

Discussion

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Cite This Study

Auricchio et al. (2026) conducted an observational in Spontaneous subarachnoid hemorrhage (n=108). Elevated early serum S100B levels vs. Lower serum S100B levels was evaluated on Unfavorable functional outcome (mRS 3-6) at 14 days associated with 24-hour log-transformed S100B (T0) (adjusted OR 3.40, 95% CI 1.80-6.43, p=<0.001). Higher log-transformed early serum S100B levels measured 24 hours post-admission were independently associated with increased odds of an unfavorable functional outcome at 14 days (adjusted OR 3.40).

synapsesocial.com/papers/6ad0fd553afa093ea9ad039b https://doi.org/10.1007/s12035-026-06202-2

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Serum S100B and Clinical Outcomes After Spontaneous Subarachnoid Hemorrhage: A Prospective Observational Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Serum S100B and Clinical Outcomes After Spontaneous Subarachnoid Hemorrhage: A Prospective Observational Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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