S100B Protein May Detect Brain Death Development after Severe Traumatic Brain Injury

Abstract

Despite improvements in the process of organ donation and transplants, the number of organ donors is progressively declining in developed countries. Therefore, 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 (Glasgow Coma Scale score [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 pre-hospital desaturation, CT scan results, isolated TBI or other related injuries, Injury Severity Score (ISS), serum S100B levels at admission and 24 h 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 h post-admission had odds ratios (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 h S100B sample in the model (OR = 15.5; p = 0.009). Receiver operating characteristics (ROC) curve analysis on this group showed the highest area under the curve (AUC) (0.86; p = 0.001) for 24 h S100B determinations. The cut off was set at 0.372 lg/L (85.7% sensitivity, 79.3% specificity, positive predictive value [PPV] = 18.7% and negative predictive value [NPV] = 98.9%). This study shows that pupillary responsiveness at admission, as well as 24 h serum S100B levels, could serve as screening tools for the early detection of patients at risk for BD after severe TBI.

Stężenie białka S100B w surowicy krwi dawców narządów po stwierdzonej śmierci mózgu — doniesienie wstępne

“…Nevertheless, the obtained results seemed to be interesting enough that it was decided to present them in the form of a preliminary report. Third, in the present study, a single measurement of serum S100B protein concentration was used; previous publications showed that the concentration of that protein differs over time after an injury [7,14]. Finally, serum S100B protein concentration correlates with scores in the GOS scale [6]; thus, the difference between the studied group and the control subjects could result at least partially from that fact.…”

“…Similar results were obtained by Egea-Gurererro et al in patients after severe brain damage with brain death confirmation; with a cut-off point of 2.0 µg L -1 , the value of the AUROC was 0.92 with a specificity of 100%, a sensitivity of 60% and an odds ratio of OR = 8.38 [12]. In previous studies with lower cut-off thresholds (0.365 µg L -1 [13], 0.372 µg L -1 [14]), the diagnostic accuracy was also lower (0.75 [13] and 0.78 [14], respectively). In a meta-analysis involving 39 cohort studies, the cut-off point for death prediction (with a specificity of 100%) ranged from 1.38 to 10.50 µg L -1 , and for predicting impaired neurological state (GCS ≤ 3 points), the cut-off point ranged from 2.16 to 14 µg L -1 [5].…”

“…Spinal reflexes could be present in up to 75% of patients after brain death confirmation [19] involving pronation reflex, the flexion of upper extremities, abdominal reflexes or flexion movements of lower extremities. In contrast, simultaneous assessment of pupillary reflex and serum S100B protein concentration comprise an algorithm for an early appointment with the commission within the procedure of brain death prediction that is suggested in the literature [14].…”

Analysis of S100 Calcium Binding Protein B Serum Levels in Different Types of Traumatic Intracranial Lesions

“…6 In patients with minor brain injury ( MBI) 7 as well as in patients with severe brain injury, a significant correlation between S100B levels and an unfavourable outcome was identified. 8,9 There are contradictive reports on the expression of S100B in different types of TBI: S100B proteins were reported at high levels in cerebrospinal fluid (CSF) after subarachnoid hemorrhage (SAH). 10 Biberthaler et al 4 reported highest levels of S100B in patients with epidural hematomas, followed by subdural, subarachnoid hemorrhage and brain contusions, whereas in another study, S100B levels in patients with epidural hematomas were shown to be normal.…”

Blood biomarkers for evaluation of perinatal encephalopathy: state of the art

“…It may be possible to use S100B as a biomarker of brain injury if measured immediately after injury; however, most mild brain injury patients are not evaluated at the time the injury occurs (Guingab-Cagmat et al, 2013). S100B levels in blood at 24 h post-traumatic brain injury provides an early and sensitive biomarker for the prediction of brain damage which may be useful in defining early risk patterns (Egea-Guerrero et al, 2013). Elevated serum levels of S100B correlate with MRI abnormality and neuropsychological examination after mild traumatic brain injury (Ingebrigtsen et al, 1999).…”