Research Reports - Multiple indicators model of long-term mortality in traumatic brain injury
Brain Inj. 2012 Jun 21
Gradisek P, Osredkar J, Korsic M, Kremzar B
Objective: To examine the prognostic ability of protein S100B, neuron-specific
enolase (NSE) and glial fibrillary acid protein (GFAP) for prediction of 1-year
mortality in patients with traumatic brain injury (TBI) in relation to clinical
and radiological characteristics of TBI. Methods: Brain injury was quantified in
84 patients (Glasgow Coma Scale [GCS] ≤ 12) using clinical (GCS, pupils),
radiological (computed tomography [CT] classification and individual CT
characteristics) and biochemical (S100B, NSE and GFAP) data at admission and in
the acute post-injury period. Results: Initial and peak S100B, NSE and GFAP
concentrations were higher in non-survivors (n = 26) than in survivors (p-value
range: <0.001-0.018). Cox regression showed that GFAP and S100B concentration and
the temporal profile of S100B were more powerful independent predictors of
mortality than baseline clinical and radiological characteristics or clinical and
radiological indicators of neurological deterioration. The prognostic models
containing admission variables and those available during the subsequent clinical
course showed the same discrimination ability (area under receiver characteristic
curve 0.92), but the model based on variables available in the acute post-injury
period calibrated better (p = 0.428). Conclusion: Mortality at 1-year post-TBI is
accurately predicted by the combination of GFAP and S100B concentration and
clinical and radiological characteristics at admission or in the acute
post-injury period.
