Reliability of S100B in predicting severity of central nervous system injury

Abstract

S100B is a protein biomarker that reflects CNS injury. It can be measured in the CSF or serum with readily available immunoassay kits. The excellent sensitivity of S100B has enabled it to confirm the existence of subtle brain injury in patients with mild head trauma, strokes, and after successful resuscitation from cardiopulmonary arrest. The extent of S100B elevation has been found to be useful in predicting clinical outcome after brain injury. Elevations of S100B above certain threshold levels might be able to reliably predict brain death or mortality. A normal S100B level reliably predicts the absence of significant CNS injury. The specificity of S100B levels as a reflection of CNS injury is compromised by the findings that extra-cranial injuries can lead to elevations in the absence of brain injury. This potential problem can most likely be avoided by measuring serial S100B levels along with other biomarkers and carefully noting peripheral injuries. Serum markers GFAP and NSE are both more specific for CNS injury and have little to no extra-cranial sources. Sustained elevations of S100B over 24 h along with elevations of GFAP and NSE can more reliably predict the extent of brain injury and clinical outcomes. In the future, S100B measurements might reliably predict secondary brain injury and enable physicians to initiate therapeutic interventions in a timelier manner. S100B levels have been shown to rise hours to days before changes in ICP, neurological examinations, and neuroimaging tests. S100B levels may also be used to monitor the efficacy of treatments.

Post resuscitation care

“…In Patienten, die eine TTMBehandlung erhielten, variierte die NSESchwellenkonzentration für 0 % FPR zwischen 49,6 und 151,4 µg/l bei 24 h [313,[322][323][324][325][326] [330][331][332] [323,324,334]. In einer Sekundärana -lyse der TTM-Studie wurden die NSESerumkonzentrationen nach 24, 48 und 72 h bei 686 Patienten gemessen.…”

Biomarkers in Neurocritical Care

“…S100B is a glial-derived protein that is released by astrocytes in proportion to the degree of brain injury [26]. One study found a 24-h S100B value >1.03 ug/l provided a sensitivity of 94% and a specificity of 83% for the development of malignant edema [27].…”

“…Existing clinical prognostic tools, based on age, pupil reactivity, and initial GCS [55] do not provide the level of detail that many families seek in their decision-making [26]. Several neuroimaging and blood proteins are used as prognostic biomarkers.…”

“…S100beta is a protein in glial cells that when elevated can predict poor outcome [62], particularly around a threshold of 2.0 ug/l. However, S100B expression is not limited to the central nervous system, and it can be elevated in the setting of significant extra-cranial injuries which are common in TBI patients [26]. Glial fibrillary acid protein is a brain-specific protein that is expressed in high levels in astrocyte; it is released in the blood after acute brain injury and has been reported to predict clinical outcome and mortality [63,64].…”

S100B protein in serum is elevated after global cerebral ischemic injury

“…S100B protein in the serum of patients with traumatic brain injury (TBI) will rise rapidly within 6 hours after injury. Studies[9,10] have proved that the higher level of S100B protein in serum, the more risks the patients with TBI. It is also reported that S100B protein could predict the prognosis of patients with TBI.…”