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. 2013 Jun 1;30(11):946-57.
doi: 10.1089/neu.2012.2579.

S100b as a prognostic biomarker in outcome prediction for patients with severe traumatic brain injury

Akash Goyal  1 , Michelle D Failla, Christian Niyonkuru, Krutika Amin, Anthony Fabio, Rachel P Berger, Amy K Wagner
Affiliations

S100b as a prognostic biomarker in outcome prediction for patients with severe traumatic brain injury

Akash Goyal et al. J Neurotrauma. .

Abstract

As an astrocytic protein specific to the central nervous system, S100b is a potentially useful marker in outcome prediction after traumatic brain injury (TBI). Some studies have questioned the validity of S100b, citing the extracerebral origins of the protein as reducing the specificity of the marker. This study evaluated S100b as a prognostic biomarker in adult subjects with severe TBI (sTBI) by comparing outcomes with S100b temporal profiles generated from both cerebrospinal fluid (CSF) (n = 138 subjects) and serum (n = 80 subjects) samples across a 6-day time course. Long-bone fracture, Injury Severity Score (ISS), and isolated head injury status were variables used to assess extracerebral sources of S100b in serum. After TBI, CSF and serum S100b levels were increased over healthy controls across the first 6 days post-TBI (p ≤ 0.005 and p ≤ 0.031). Though CSF and serum levels were highly correlated during early time points post-TBI, this association diminished over time. Bivariate analysis showed that subjects who had temporal CSF profiles with higher S100b concentrations had higher acute mortality (p < 0.001) and worse Glasgow Outcome Scale (GOS; p = 0.002) and Disability Rating Scale (DRS) scores (p = 0.039) 6 months post-injury. Possibly as a result of extracerebral sources of S100b in serum, as represented by high ISS scores (p = 0.032), temporal serum profiles were associated with acute mortality (p = 0.015). High CSF S100b levels were observed in women (p = 0.022) and older subjects (p = 0.004). Multivariate logistic regression confirmed CSF S100b profiles in predicting GOS and DRS and showed mean and peak serum S100b as acute mortality predictors after sTBI.

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Figures

FIG. 1.
FIG. 1.
Daily biomarker levels over the first 6 days after severe traumatic brain injury, compared to healthy controls. For both cerebrospinal fluid (CSF) and serum, mean peak S100b levels occur on d0. (A) Daily mean CSF S100b levels are higher than controls across all days tested (p≤0.005 all comparisons). (B) Daily mean serum S100b levels are higher than controls across all days tested (p≤0.031 all comparisons). Healthy control CSF S100b values: 0.0754±0.0034 ng/mL; healthy control serum S100b values: 0.328±0.101 pg/mL.
FIG. 2.
FIG. 2.
Serum S100b levels correlated to cerebrospinal fluid S100b levels in the overlapping sample between the two compartments showing decreasing correlation over time after severe traumatic brain injury. (A) Subjects who had CSF and serum S100b levels at d0 (n=11; r=0.787). (B) Subjects who had CSF and serum S100b levels at d1 (n=32; r=0.575). (C) Subjects who had CSF and serum S100b levels at d4 (n=21; r=0.323). (D) Subjects who had CSF and serum S100b levels at both d0 and d1 (n=9; r=0.958).
FIG. 3.
FIG. 3.
Trajectory groups for profiles (TRAJ) over the first 6 days after severe traumatic brain injury, compared to healthy controls. (A) Mean cerebrospinal fluid S100b levels are shown for three statistically distinct TRAJ groups. At least one TRAJ group was significantly different from the other two TRAJ groups across all time points tested (p<0.001 all comparisons). (B) Mean serum S100b levels are shown for two statistically distinct TRAJ groups. The two TRAJ groups were significantly different across all time points tested (p≤0.024 all comparisons). Healthy control CSF S100b values: 0.0754±0.0034 ng/mL; healthy control serum S100b values: 0.328±0.101 pg/mL.
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