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Secondary Peaks of S100B in Serum Relate to Subsequent Radiological Pathology in Traumatic Brain Injury

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Abstract

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.

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Conflict of interest

Eric P. Thelin, David W. Nelson, and Bo-Michael Bellander declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Clinical Neuroscience, Section for Neurosurgery, Karolinska Institutet, Karolinska University Hospital Solna, R2:02, 171 76, Stockholm, Sweden

    Eric P. Thelin & Bo-Michael Bellander

  2. Section of Anesthesiology and Intensive Care, Department of Physiology and Pharmacology, Karolinska Institutet, 171 77, Stockholm, Sweden

    David W. Nelson

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  1. Eric P. Thelin
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Correspondence to Eric P. Thelin.

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Thelin, E.P., Nelson, D.W. & Bellander, BM. Secondary Peaks of S100B in Serum Relate to Subsequent Radiological Pathology in Traumatic Brain Injury. Neurocrit Care 20, 217–229 (2014). https://doi.org/10.1007/s12028-013-9916-0

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