The objective of our study was to investigate the association between the initial levels of serum S-100B protein and neuron specific enolase and the severity of radiologically visible brain damage and outcome after severe head injury. Admission computed tomography (CT) scans of forty-four patients with severe head injury were analysed. Initial levels of S-100B protein and neuron specific enolase were compared between the different outcome groups at 6 month, the different categories of the Marshall classification, the presence of traumatic subarachnoid haemorrhage, the type of haematoma and the volume of contusion. Serum S-100B was significantly higher in patients with unfavourable outcome (1.1 micrograms/l versus 0.3 microgram/l, p < 0.005, Mann-Whitney U test). In diffuse injury, unfavourable outcome significantly increased with higher Marshall grades (p < 0.05). There was a significant correlation between the four grades of diffuse injury and initial serum S-100B protein (r = 0.48, p < 0.001). Patients with focal mass lesions and a favourable outcome after 6 month had significantly lower S-100B values than those who had an unfavourable outcome (0.51 microgram/l versus 1.3 micrograms/l, p < 0.05). A significant correlation was demonstrated between the volume of contusion visible on CT scans and serum S-100B (r = 0.58, p < 0.001). In our study, initial serum S-100B protein was a powerful predictor of outcome even within the same category of radiologically visible brain damage. Serum S-100B protein may provide independent information about the severity of primary brain damage after head injury.
The objective of the study was to investigate the validity of outcome prediction after severe head injury using serum levels of S-100B protein and neuron specific enolase. Eighty-two patients with severe head injury were included in this prospective study. Venous blood samples were taken after admission and every 24 h for a maximum of 10 consecutive days. For values of S-100 from 0 to 2.5 micrograms/l, and for values of NSE from 0 to 100 micrograms/l the sensitivity and specificity of incremental values as a predictor of unfavourable outcome were calculated and Receiver Operator Characteristics curves were plotted. Serum S-100 protein was found to be clearly superior to neuron specific enolase in terms of predicting outcome with higher specificity, sensitivity, positive and negative predictive value. According to our experience, S-100B protein represents the most promising serum marker of brain cell damage currently under investigation.
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