Clinical Significance of Serum Biomarker S100B to Predict Outcome After Traumatic Brain Injury

Ghanshyam Gahlot, Yogita Soni, Gajanand Joshi, Rachit Saxena

Abstract


Background: Traumatic brain injury (TBI) is a common cause of death and disability, worldwide. Early recognition of patients with brain cellular damage allows for early rehabilitation and patient outcome improvement. Serum protein S-100B determinations have been widely suggested the most promising biomarker for TBI. It has been proposed that this marker is useful in a Neurointensive Care Unit (NICU) as a monitoring parameter. The main objective of this study is to assess the value of including acute S100B levels in standard clinical data as an early screening tool for brain death after severe TBI. Material and methods: In this prospective study, the clinical conditions of patients with mild to moderate TBI were assessed and patient serum S100B levels measured within 24h of injury were eligible for inclusion in the study using by electro chemiluminescence (ECL). Patients were admitted to The Govt. Trauma Centre, P.B.M. Hospital, Bikaner in NICU and followed up one month later and evaluated for level of consciousness, presence or absence of post-traumatic headache, and daily activity performance (using the Barthel scale). Student’s t-test and the chi-square test were used for the data analysis, which was performed using SPSS software. Result and discussion: The mean serum S100B value was significantly lower for patients with minor TBI than for patients with moderate TBI (20.4 ± 12.6 ng/dl and 124.0 ± 235.0 ng/dl, respectively). Patients with normal CT scans also had statistically significantly lower serum S100B levels than patients with abnormal CT findings. The mean S100B value was statistically significantly higher for patients with suspected diffused axonal injury (596.18 ± 502.1 ng/dl) than for patients with other abnormal CT findings (p=0.000): 20.97 ± 19.9 ng/dl in patients with normal CT results; 39.56 ± 21.7 ng/dl in patients with skull bone fracture; 50.38 ± 22.9 ng/dl in patients with intracranial haemorrhage; and 70.23 ± 31.3 ng/dl in patients with fracture plus intracranial haemorrhage. Conclusion: Serum S100B levels increase in patients with minor to moderate TBIs, especially in those with diffused axonal injury. However, serum S100B values cannot accurately predict one-month neuropsychological outcomes and performance.

KEYWORDS: Skull bone fracture, Axonal injury, Haemorrhage, Neuropsychological, SPSS Software, Post-traumatic Headache, Abnormal CT


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References


Steyerberg EW, Mushkudiani N, Perel P, Butcher I, Lu J, McHugh GS, et al. Predicting outcome after traumatic brain injury: development and international validation of prognostic scores based on admission characteristics. PLoS Med 2008;5:1251–61.

MRC CRASH Trial Collaborators, Perel P, Arango M, Clayton T, Edwards P, Komolafe E, et al. Predicting outcome after traumatic brain injury: practical prognostic models based on large cohort of international patients. Br Med J 2008;336:425–9.

Hukkelhoven CW, Rampen AJ, Maas AI, Farace E, Habbema JD, Marmarou A, et al. Some prognostic models for traumatic brain injury were not valid. J Clin Epidemiol 2006;59:132–43.

Maas AI, Marmarou A, Murray GD, Teasdale SG, Steyerberg EW. Prognosis and clinical trial design in traumatic brain injury: the IMPACT study. J Neurotrauma 2007;24:232–8.

Berger RP. The use of serum biomarkers to predict outcome after traumatic brain injury in adults and children. J Head Trauma Rehabil 2006;21:315–33.

Kochanek PM, Berger RP, Bayir H, Wagner AK, Jenkins LW, Clark RS. Biomarkers of primary and evolving damage in traumatic and ischemic brain injury: diagnosis, prognosis, probing mechanisms,

and therapeutic decision making. Curr Opin Crit Care 2008;14:135–41.

Dassan P, Keir G, Brown MM. Criteria for a clinically informative serum biomarker in acute ischaemic stroke: a review of S100B.Cerebrovasc Dis 2009;27:295–302.

Brouns R, De Vil B, Cras P, De Surgeloose D, Marien P, De Deyn PP. Neurobiochemical markers of brain damage in cerebrospinal fluid of acute ischemic stroke patients. Clin Chem 2010;56:451–8.

Hamed SA, Hamed EA, Abdella MM. Septic encephalopathy: relationship to serum and cerebrospinal fluid levels of adhesion molecules, lipid peroxides and S-100B protein. Neuropediatrics

;40:66–72.

Ide T, Kamijo Y, Ide A, Yoshimura K, Nishikawa T, Soma K, et al. Elevated S100B level in cerebrospinal fluid could predict poor outcome of carbon monoxide poisoning. Am J Emergency Med 2012;30:222–5.

Nylen K, Ost M, Csajbok LZ, Nilsson I, Hall C, Blennow K, et al. Serum levels of S100B, S100A1B and S100BB are all related to outcome after severe traumatic brain injury. Acta Neurochir (Wien)

;150:221–7.

Savola O, Pyhtinen J, Leino TK, Siitonen S, Niemela O, Hillbom M. Effects of head and extracranial injuries on serum protein S100B levels in trauma patients. J Trauma 2004;56:1229–34.

Raabe A, Kopetsch O, Woszczyk A, Lang J, Gerlach R, Zimmermann M, et al. Serum S-100B protein as a molecular marker in severe traumatic brain injury. Restor Neurol Neurosci 2003;21:159–69.

Wiesmann M, Steinmeier E, Magerkurth O, Linn J, Gottmann D, Missler U. Outcome prediction in traumatic brain injury: comparison of neurological status, CT findings, and blood levels of S100B and GFAP. Acta Neurol Scand 2010;121:178–85.

Kleindienst A, Ross Bullock M. A critical analysis of the role of the neurotrophic protein S100B in acute brain injury. J Neurotrauma 2006;23:1185–200.

Anderson RE, Hansson LO, Nilsson O, Dijlai- Merzoug R, Settergren G. High serum S100B levels for trauma patients without head injuries.

Neurosurgery 2001;48:1255–60.

Willoughby KA, Kleindienst A, Muller C, Chen T, Muir JK, Ellis EF. S100B protein is released by in vitro trauma and reduces delayed neuronal injury. J Neurochem 2004;91:1284–91.

Jackson RG, Samra GS, Radcliffe J, Clark GH, Price CP. The early fall in levels of S-100 beta in traumatic brain injury. Clin Chem Lab Med 2000;38:1165–7.

Shinozaki K, Oda S, Sadahiro T, Nakamura M, Hirayama Y, Abe R, et al. S100B and neuron-specific enolase as predictors of neurological outcome in patients after cardiac arrest and return of spontaneous circulation: a systematic review. Crit Care 2009;13:R121.

Mahoney Fi, Barthel DW. Functional evaluation: the Barthel index. MD State Med J 1965;14:61–5.

Shah S, Vanclay F, Cooper B. Improving the sensitivity of the Barthel index for stroke rehabilitation. J ClinEpidemiol1989;42:703–9.

Sulter G, Steen C, De Keyser J. Use of the Barthel index and modified Rankin scale in acute stroke trials. Stroke1999;30:1538–41.

Bloomfield SM, McKinney J, Smith L, Brisman J. Reliability of S100B in predicting severity of central nervous system injury. Neurocrit Care 2007;6:121– 38.

Winter CD, Clough GF, Pringle AK, Church MK. Outcome following severe traumatic brain injury TBI correlates with serum S100B but not brain extra cellular fluid S100B: an intracerebral microdialysis study. World J Neurosci 2013;3:93–9.

Kleindienst A, Ross Bullock M. A critical analysis of the role of the neurotrophic protein S100B in acute brain injury. J Neurotrauma 2006;23:1185–200.

Kleindienst A, Schmidt C, Parsch H, Emtmann I, Xu Y, Buchfelder M. The passage of S100B from brain to blood is not specifically related to the blood-brain barrier integrity. Cardiovasc Psychiatry Neurol

;2010:801295.

Townend W, Ingebrigtsen T. Head injury outcome prediction: a role for protein S-100B?. Injury 2006;37:1098–108.

Metting Z, Wilczak N, Rodiger LA, Schaaf JM, van der Naalt J. GFAP and S100B in the acute phase of mild traumatic brain injury. Neurology 2012;78:1428–33.

Egea-Guerrero JJ, Murillo-Cabezas F, Gordillo- Escobar E, Rodriguez-Rodriguez A, Enamorado- Enamorado J, Revuelto-Rey J, et al. S100B protein may detect brain death development after severe

traumatic brain injury. J Neurotrauma 2013;30:1762– 9.




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