Plasma-based S100B testing for management of traumatic brain injury in emergency setting

Abstract

Background Serum biomarker S100B has been explored for its potential benefit to improve clinical decision-making in the management of patients suffering from traumatic brain injury (TBI), especially as a pre-head computed-tomography screening test for patients with mild TBI. Although being already included into some guidelines, its implementation into standard care is still lacking. This might be explained by a turnaround time (TAT) too long for serum S100B to be used in clinical decision-making in emergency settings. Methods S100B concentrations were determined in 136 matching pairs of serum and lithium heparin blood samples. The concordance of the test results was assessed by linear regression, Passing Pablok regression and Bland-Altman analysis. Bias and within- and between-run imprecision were determined by a 5 × 4 model using pooled patient samples. CT scans were performed as clinically indicated. Results Overall, S100B levels between both blood constituents correlated very well. The suitability of S100B testing from plasma was verified according to ISO15189 requirements. Using a cut-off of 0.105 ng/ml, a sensitivity and negative predictive value of 100% were obtained for identifying patients with pathologic CT scans. Importantly, plasma-based testing reduced the TAT to 26 min allowing for quicker clinical decision-making. The clinical utility of integrating S100B in TBI management is highlighted by two case reports. Conclusions Plasma-based S100B testing compares favorably with serum-based testing, substantially reducing processing times as the prerequisite for integrating S100B level into management of TBI patients. The proposed new clinical decision algorithm for TBI management needs to be validated in further prospective large-scale studies.

Plasma levels of S100B and neurofilament light chain protein in stress-related mental disorders

“…The mean level of S100B in patients with SED in the current study (0.388 ng/ml) exceeded a suggested reference level used to identify pathological CT scans in hospital emergency settings after traumatic brain injury (≥ 0.105 ng/ml) 15 . However, caution must be used in interpreting the meaning of this difference, as the previous study used a different method to measure serum levels of S100B (the Elecys ® S100 assay on a Cobas e411 instrument, both from Roche Diagnostics, Germany).…”

“…S100B is a cytosolic calcium-binding protein 13 synthesized primarily by astrocytes 14 . Raised levels of S100B are used clinically as an indicator of brain damage 15 and may be a marker of neurological disorders 16 . S100B is hypothesized to be a marker of blood brain barrier integrity 17 and has been found in the cerebrospinal fluid (CSF) and serum of patients with mood disorders, including MDD 18 – 21 .…”

Significance of S100B Protein as a Rapid Diagnostic Tool in Emergency Departments for Traumatic Brain Injury Patients

“…Establishing a TBI biomarker, potentially the S100B protein, could possibly decrease the number of unnecessary CT scans performed for patients after head trauma and economize hospital costs [31]. Our study does not include a cost-effectiveness analysis, but each biochemical test performed serially is cheaper than an imaging test.…”

Trauma diagnostic-related target proteins and their detection techniques

“…They also found that plasma-based S100B detection is superior to serum-based detection, significantly reducing processing time (Ref. 71 ). GFAP is a specific intermediate filament protein found in astrocytes and is upregulated during astrocyte proliferation.…”