S100B Is Not a Reliable Prognostic Index in Paediatric TBI

Abstract

Background: As far as paediatric traumatic brain injury is concerned, it is difficult to quantify the extent of the primary insult, to monitor secondary changes and to predict neurological outcomes by means of the currently used diagnostic tools: physical examination, Glasgow Coma Scale (GCS) score and computed tomography. For this reason, several papers focused on the use of biochemical markers (S100B, neuron-specific enolase) to detect and define the severity of brain damage and predict outcome after traumatic head injury or cardiac arrest. Objective: The aim of this paper is measuring the range of S100B serum concentrations in children affected by traumatic brain injury and describing the possible roles of this protein in the reaction to trauma. Methods: Fifteen children aged 1–15 years were included in the study. Traumatic brain injury severity was defined by paediatric GCS score as mild (9 patients), moderate (2 patients) or severe (4 patients). Blood samples for S100B serum measurement were taken at emergency department admission and after 48 h. Results: The serum S100B concentration was higher in the group of severe trauma patients, who scored the lowest on the GCS at admission, and among them, the highest values were reported by the children with concomitant peripheral lesions. Conclusions: The role of S100B in paediatric traumatic brain injury has not been clarified yet, and the interpretation of its increase when the head trauma is associated with other injuries needs the understanding of the physiopathological mechanisms that rule its release in the systemic circulation. The levels of S100B in serum after a brain injury could be related to the mechanical discharge from a destroyed blood-brain barrier, or they could be due to the active expression by the brain, as a part of its involvement in the systemic inflammatory reaction. Early increase of this protein is not a reliable prognostic index of neurological outcome after pediatric traumatic brain injury, since even very elevated values are compatible with a complete neurological recovery.

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“…130 As with all biomarkers, the role of S100B in TBI management in children is even less clear, 131 with some arguing that this marker has little diagnostic or prognostic utility in paediatric populations. 132 In a study of children with TBI aged ≤15 years, those <5 years or >9 years of age had higher serum levels of S100B than did those aged 5-9 years. 133 S100B may, therefore, be an inadequate marker to distinguish between symptomatic and asymptomatic children with concussion, 133 and the utility of S100B in diagnostics and outcome prognosis is questionable.…”

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“…However, some studies reported a poor value of S100B as a predictor of outcome after brain injury, particularly mild and pediatric TBI. A poor correlation was found between serum and brain S100B values, suggesting that the serum levels may depend primarily on the integrity of the blood-brain-barrier and do not reflect the S100B levels in the brain 6,15 . Despite apparent controversy, S100B still has potential as a brain injury biomarker, and its preclinical and clinical utility should be further explored.…”

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“…This has raised concerns as to whether the serum levels of this protein actually correlate with the degree of brain damage or are more reflective of other processes. Finally, because of the high normative values in the pediatric population, S100B is not a useful marker in children (Piazza et al 2007, Berger et al 2006.…”