Research Reports - S100B Protein may detect brain death development after severe traumatic brain injury

J Neurotrauma. 2013 May 27

Egea-Guerrero JJ, Murillo-Cabezas F, Gordillo-Escobar E, Rodríguez-Rodríguez A, Enamorado-Enamorado J, Revuelto-Rey J, Pacheco-Sánchez M, León-Justel A, Domínguez-Roldán JM, Vilches-Arenas A

Despite improvements in the process of organ donation and transplants, the number
of organ donors is progressively declining in developed countries. Thus, the
early detection of patients at risk for brain death (BD) is a priority for
transplant teams seeking more efficient identification of potential donors. In
the extensive literature on S100B as a biomarker for traumatic brain injury
(TBI), no evidence appears to exist on its prognostic capacity as a predictor of
BD after severe TBI. The objective of this study is to assess the value of
including acute S100B levels in standard clinical data as an early screening tool
for BD after severe TBI. This prospective study included patients with severe TBI
(GCS≤8) admitted to our Neurocritical Care Unit over a 30-month period. We
collected the following clinical variables: age, gender, GCS score, pupillary
alterations at admission, hypotension and prehospital desaturation, CT-scan
results, isolated TBI or other related injuries, ISS, serum S100B levels at
admission and 24 hours post-admission, and a final diagnosis regarding BD. Of the
140 patients studied, 11.4% developed BD and showed significantly higher S100B
concentrations (p<0.001). Multivariate analysis showed that bilateral
unresponsive mydriasis at admission and serum S100B at 24 hours post-admission
had ORs of 21.35 (p=0.005) and 4.9 (p=0.010), respectively. The same analysis on
patients with photomotor reflex in one pupil at admission left only the 24-hour
S100B sample in the model (OR=15.5; p=0.009). ROC curve analysis on this group
showed the highest AUC (0.86; p=0.001) for 24-hour S100B determinations. The
cut-off was set at 0.372 µg/L (85.7% sensitivity, 79.3% specificity, PPV=18.7%
and NPV=98.9%). This study shows that pupillary responsiveness at admission, as
well as 24-hour serum S100B levels, could serve as screening tools for the early
detection of patients at risk for BD after severe TBI.

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