S100B Serum Level as a Mortality Predictor for Traumatic Brain Injury: A Meta-Analysis

Abstract

BACKGROUND:The pathogenesis of inflammatory neuronal cell damage will continue after traumatic brain injury in which contributed to subsequent mortality. Serum S100B levels were shown to be an early predictor of mortality due to traumatic brain injury.AIM:This Meta-Analysis will analyse the mean and diagnostic strength of serum S100B levels between survived and died subjects with head injuries based on the various follow-up times of nine studies.METHODS:We conducted a meta-anelysis in accordance with PRISMA guidelines and adhering to Cochrane Handbook for Systematic Review of Interventions. Literature search was conducted on March 16, 2018 from Medline and Scopus in the past 10 years, using various keywords related to S100, brain injury, and outcome. Duplicate journals were sorted out via EndNote. Included articles were as follows: original data from the group, clinical trials, case series, patients undergoing serum S100B levels with both short- and long-term follow-up mortality. Data were collected for mortality, serum S100B levels, and its diagnostic strength. All data were analyzed using Review Manager 5.3 (Cochrane, Denmark).RESULTS:The results of the meta-analysis showed a significant difference in S100B levels between survived and died subjects with head injuries on overall follow-up timeline (0.91, 95.9% CI 0.7-1.12, I2 = 98%, p < 0.001), during treatment (1.43, 95% CI 0.97 to 1.89, I2 = 98%, p < 0.001), or 6 months (0.19; 95%CI 0.1-0.29, I2 = 76%, p < 0.001) with an average threshold value that varies according to the study method used. The mean diagnostic strength was also promising to predict early mortality (sensitivity of 77.18% and 92.33%, specificity of 78.35% and 50.6%, respectively).CONCLUSION:S100B serum levels in the future will be potential biomarkers, and it is expected that there will be standardised guidelines for their application.

Usability of the Level of the S100B Protein, the Gosling Pulsatility Index, and the Jugular Venous Oxygen Saturation for the Prediction of Mortality and Morbidity in Patients with Severe Traumatic Brain Injury

“…To date, several analyses have been reported on the usability of S100B protein levels in assessing the severity of TBI [ 41 – 44 ]. However, none performed a combined analysis of the levels of S100B protein, Gosling's pulsatility index, and jugular venous oxygen saturation for the prediction of mortality and morbidity among patients with TBI.…”

Damage-associated molecular patterns in trauma

“…However, more recent studies imply the negative role of S100B in TBI and represent that S100B in CSF, as an astrocytic protein specific to the central nervous system and a useful marker in outcome prediction for TBI [ 199 , 200 ]. Thus, S100 s protein have been established as useful marker for inflammatory diseases and blood brain barrier damage, which plays an important role in the development and recovery of normal CNS after injury [ 201 – 203 ]. Recently, results of a meta-analysis showed a significant difference in S100B levels between survived and died subjects with head injuries on overall follow-up timeline, during treatment, or 6 months with an average threshold value that varies according to the study method used [ 203 ].…”

“…Thus, S100 s protein have been established as useful marker for inflammatory diseases and blood brain barrier damage, which plays an important role in the development and recovery of normal CNS after injury [ 201 – 203 ]. Recently, results of a meta-analysis showed a significant difference in S100B levels between survived and died subjects with head injuries on overall follow-up timeline, during treatment, or 6 months with an average threshold value that varies according to the study method used [ 203 ]. In terms of other S100 proteins and nervous injury, following peripheral nerve injury an immediate acute immune response distally and proximally to the lesion site with rapid transcriptional activation of S100a8 and S100a9 genes resulting in S100A8/A9 hetero- and homodimers has been observed [ 204 ].…”

“…Similar to HMGB1, S100A8 and S100A9 levels in the bloodstream increase early in the acute phase of trauma or brain injury. Thus, although large number of studies deals with neurological trauma, there is some evidence that other S100 protein, i.e., S100B is also elevated in patients with major extracranial trauma [ 203 , 206 – 208 ]. S100B concentrations upon admission correlated positively with injury severity and decreased survival in major trauma patients, observations which were independent of head injury [ 206 , 208 ].…”

Time-dependent cytokine and chemokine changes in mouse cerebral cortex following a mild traumatic brain injury

“…Regarding S100 calcium binding protein B (S100B), there have been mixed data on its utility in TBI; Golden et al, 2018 and Kövesdi et al, 2010 found it to predict poor outcomes following severe TBI, whereas Shahim et al, 2016 determined that it was unhelpful in predicting patient outcomes ( Golden et al, 2018 ; Kövesdi et al, 2010 ; Shahim et al, 2016 ). Potential biomarkers for mTBI have likewise been investigated, and plasma/serum levels of NFL, UCH-L1 and tau (a microtubule-associated protein) were observed to be potentially useful ( Joseph et al, 2018 ; Shahim et al, 2017 ).…”