Objective: To prospectively study S-100B and NSE levels, in subjects treated for severe head injury (sTBI), and investigate the prognostic value of these biomarkers.
Methods: Subjects included in a prospective double blinded randomised study for sTBI. Inclusion criteria; Glasgow Coma Score (GCS) ≤8, age 15 – 70 years, first recorded cerebral perfusion pressure of > 10 mmHg, and arrival < 24 hours after trauma. Subjects were treated with an intracranial pressure (ICP) targeted therapy. Blood samples for S-100B and NSE were drawn immediately after arrival and every 12 hour for five days. Outcome was evaluated as Glasgow Outcome Scale (GOS) by independent staff at 3 and 12 months.
Results: 48 subjects, mean age 35.5 years, and median GCS 6 were included. The first blood sample was drawn at 15.6 ± 1.4 hours after injury. Initial concentration of S-100B was 1.04 ± 0.21 µg/l and for NSE 18.94 ± 2.32 µg/l. The biomarkers were significantly higher in subjects with those included as GCS 3 and in those who died as compared with GCS 4 – 8 and GOS 2 – 5, respectively. ROC curve analyses of the initial S-100B and NSE levels to GOS dichotomised as unfavourable (GOS 1-3) and favourable (GOS 4-5) showed a weak correlation; AUC 0.585 and 0.555 respectively. Using the dichotomisation dead (GOS 1) / alive (GOS 2-5), the AUC was 0.687 and 0.734 respectively. Further, a correlation was found between the biomarkers themselves and the biomarkers and ICP.
Conclusion: We can at 3 and 12 months after trauma neither show any difference of prognostic values between the markers nor show any clinical significant value of the markers as predictors of clinical outcome.