目的:卒中是全球死亡率和致残的主要原因。本研究旨在评估血清S100B蛋白的预后价值。经颅彩色编码双工超声(TCCD),和视神经鞘直径(ONSD)在预测急性缺血性卒中(AIS)危重患者的功能结局中的作用。
方法:在这项前瞻性观察研究中,对80例成人AIS患者进行了评估。血清S100B蛋白水平,ONSD,在第1天和第3天测量大脑中动脉搏动指数(MCAPI)。使用改良的Rankin量表(mRS)评估90天的功能结果,并分为有利(mRS0-2)或不利(mRS3-6)组。人口统计的关联,临床,实验室,并分析了成像参数与mRS结果的关系。
结果:82.5%的患者mRS结局较差。与不良结局显着相关的因素是女性,美国国立卫生研究院卒中量表(NIHSS)评分在第1天,第3天和第7天,卒中规模更大.受试者工作特征(ROC)曲线分析显示,第1天和第3天的ONSD,第1天的血清S100B水平和第1天的右MCAPI对不良的mRS结果具有显着的预测价值。多变量分析确定了女性性别,第1天的S100B和第1、3和7天的NIHSS是mRS结局差的独立预测因子。
结论:S100B的组合,ONSD,和MCAPI改善了对危重AIS患者功能结局的预测。早期S100B测量和脑超声评估可作为指导治疗决策的有价值的预后工具。这项研究为S100B和脑超声在卒中结局预测中的作用提供了新的见解。特别是在危重AIS患者中。
OBJECTIVE: Stroke is a leading cause of mortality and disability worldwide. This study aimed to assess the prognostic value of serum S100B protein, transcranial color-coded duplex sonography (TCCD), and optic nerve sheath diameter (ONSD) in predicting functional outcomes in critically ill patients with acute ischemic stroke (AIS).
METHODS: In this prospective observational study, 80 adult AIS patients were evaluated. Serum S100B protein levels, ONSD, and middle cerebral artery pulsatility index (MCA PI) were measured on days 1 and 3. Functional outcomes at 90 days were assessed using the modified Rankin Scale (mRS) and categorized into favourable (mRS 0-2) or unfavourable (mRS 3-6) groups. The association of demographic, clinical, laboratory, and imaging parameters with mRS outcomes was analyzed.
RESULTS: Poor mRS outcomes occurred in 82.5 % of patients. Factors significantly associated with poor outcomes were female sex, higher National Institutes of Health Stroke Scale (NIHSS) scores on days 1, 3, and 7, and larger stroke size. Receiver Operating Characteristic (ROC) curve analysis revealed that ONSD at days 1 and 3, serum S100B levels at day 1, and right MCA PI at day 1 had significant predictive value for poor mRS outcome. Multivariate analysis identified female sex, S100B on day 1, and NIHSS on days 1, 3, and 7 as independent predictors of poor mRS outcomes.
CONCLUSIONS: The combination of S100B, ONSD, and MCA PI improved the prediction of functional outcomes in critically ill AIS patients. Early S100B measurement and brain ultrasound evaluation may serve as valuable prognostic tools for guiding therapeutic decision-making. This study provides novel insights into the role of S100B and brain ultrasound in stroke outcome prediction, particularly in critically ill AIS patients.