Jugular venous and arterial concentrations of serum S-100B protein in patients with severe head injury: a pilot study
- aDepartment of Neurosurgery, bDepartment of Anaesthesia, Addenbrookes Hospital, University of Cambridge, England
- Dr Andreas Raabe, Department of Neurosurgery, University of Leipzig, Johannisallee 34, 04103 Leipzig, Germany. Telephone 0049 341 9712000; fax 0049 341 9712009; emailaraa{at}server3.medizin.uni-leipzig.de
- Received 16 January 1998
- Revised 22 May 1998
- Accepted 15 June 1998
Abstract
The objective of this study was to analyse the temporal course of the jugular venous-arterial gradient of S-100B protein after severe head injury and the correlation between the absolute concentrations of serum S-100B protein and outcome, CT findings, and clinical variables.
Fifteen patients were included in this pilot study. All patients were treated according to a standard therapy protocol targeted to maintain cerebral perfusion pressure. The serum concentration of S-100 protein was measured daily for five consecutive days after injury by a monoclonal two site immunoluminometric assay. Nine patients showed favourable and six unfavourable outcome after 6 months with a mortality rate of 33% (five patients). The mean gradient between jugular venous and arterial blood was 8.2% (p<0.05). Patients showing an unfavourable outcome had significantly higher jugular venous or arterial S-100 values compared with those with a favourable outcome (jugular venous S-100B 2.78 μg/l v 1.22 μg/l, p<0.05; arterial S-100B 2.48 μg/l v 1.19 μg/l, p<0.05). All patients with an initial or secondary increase in S-100B value of >2 μg/l were found to have an unfavourable outcome. S-100B was found to be an independent predictor of outcome after severe head injury. The persisting increase of S-100B for three to five days even in patients with favourable outcome and no signs of secondary insults might reflect continuing damage to the blood-brain barrier or ongoing glial cell death.
