Research Reports - Secondary peaks of S100B relate to subsequent pathology in traumatic brain injury
Neurocrit Care. 2013 Oct 22
Thelin EP, Nelson DW, Bellander BM
INTRODUCTION: Patients suffering from severe traumatic brain injury (TBI) often
develop secondary brain lesions that may worsen outcome. S100B, a biomarker of
brain damage, has been shown to increase in response to secondary cerebral
deterioration. The aim of this study was to analyze the occurrence of secondary
increases in serum levels of S100B and their relation to potential subsequent
radiological pathology present on CT/MRI-scans.
METHODS: Retrospective study from a trauma level 1 hospital, neuro-intensive care
unit. 250 patients suffering from TBI were included. Inclusion required a minimum
of two radiological examinations and at least three serum samples of S100B, with
at least one >48 h after trauma.
RESULTS: Secondary pathological findings on CT/MRI, present in 39 % (n = 98) of
the patients, were highly correlated to secondary increases of ≥0.05 μg/L S100B
(P < 0.0001, pseudo-R (2) 0.532). Significance remained also after adjusting for
known important TBI predictors. In addition, secondary radiological findings were
significantly correlated to outcome (Glasgow Outcome Score, GOS) in
uni-(P < 0.0001, pseudo-R (2) 0.111) and multivariate analysis. The sensitivity
and specificity of detecting later secondary radiological findings was
investigated at three S100B cut-off levels: 0.05, 0.1, and 0.5 μg/L. A secondary
increase of ≥0.05 μg/L had higher sensitivity (80 %) but lower specificity
(89 %), compared with a secondary increase of ≥0.5 μg/L (16 % sensitivity, 98 %
specificity), to detect secondary radiological findings.
CONCLUSIONS: Secondary increases in serum levels of S100B, even as low as
≥0.05 μg/L, beyond 48 h after TBI are strongly correlated to the development of
clinically significant secondary radiological findings.