1 NeuroCritical Care Unit, Virgen del Rocío University Hospital, IBIS/CSIC/University of Seville , Seville, Spain .
J Neurotrauma. 2013 Oct 15;30(20):1762-9. doi: 10.1089/neu.2012.2606. Epub 2013 Aug 28.
Despite improvements in the process of organ donation and transplants, the number of organ donors is progressively declining in developed countries. Therefore, the early detection of patients at risk for brain death (BD) is a priority for transplant teams seeking more efficient identification of potential donors. In the extensive literature on S100B as a biomarker for traumatic brain injury (TBI), no evidence appears to exist on its prognostic capacity as a predictor of BD after severe TBI. The objective of this study is to assess the value of including acute S100B levels in standard clinical data as an early screening tool for BD after severe TBI. This prospective study included patients with severe TBI (Glasgow Coma Scale score [GCS] ≤ 8) admitted to our Neurocritical Care Unit over a 30 month period. We collected the following clinical variables: age, gender, GCS score, pupillary alterations at admission, hypotension and pre-hospital desaturation, CT scan results, isolated TBI or other related injuries, Injury Severity Score (ISS), serum S100B levels at admission and 24 h post-admission, and a final diagnosis regarding BD. Of the 140 patients studied, 11.4% developed BD and showed significantly higher S100B concentrations (p<0.001). Multivariate analysis showed that bilateral unresponsive mydriasis at admission and serum S100B at 24 h post-admission had odds ratios (ORs) of 21.35 (p=0.005) and 4.9 (p=0.010), respectively. The same analysis on patients with photomotor reflex in one pupil at admission left only the 24 h S100B sample in the model (OR=15.5; p=0.009). Receiver operating characteristics (ROC) curve analysis on this group showed the highest area under the curve (AUC) (0.86; p=0.001) for 24 h S100B determinations. The cut off was set at 0.372 μg/L (85.7% sensitivity, 79.3% specificity, positive predictive value [PPV]=18.7% and negative predictive value [NPV]=98.9%). This study shows that pupillary responsiveness at admission, as well as 24 h serum S100B levels, could serve as screening tools for the early detection of patients at risk for BD after severe TBI.
尽管器官捐献和移植过程有所改善，但在发达国家，器官捐献者的数量正在逐渐减少。因此，对于移植团队来说，优先考虑早期发现脑死亡（BD）风险患者，以便更有效地识别潜在供体。在 S100B 作为创伤性脑损伤（TBI）生物标志物的广泛文献中，似乎没有证据表明其作为严重 TBI 后 BD 预测因子的预后能力。本研究的目的是评估在标准临床数据中纳入急性 S100B 水平作为严重 TBI 后 BD 的早期筛查工具的价值。这项前瞻性研究纳入了在 30 个月期间入住我们神经重症监护病房的严重 TBI 患者（格拉斯哥昏迷量表[GCS]评分≤8）。我们收集了以下临床变量：年龄、性别、GCS 评分、入院时瞳孔改变、低血压和院前低氧饱和度、CT 扫描结果、孤立性 TBI 或其他相关损伤、损伤严重程度评分（ISS）、入院时和入院后 24 小时的血清 S100B 水平，以及最终关于 BD 的诊断。在研究的 140 名患者中，11.4%发生了 BD，且 S100B 浓度显著升高（p<0.001）。多变量分析显示，入院时双侧无反应性瞳孔散大和入院后 24 小时 S100B 浓度的比值比（OR）分别为 21.35（p=0.005）和 4.9（p=0.010）。对入院时单侧瞳孔光反射的患者进行相同的分析，仅将 24 小时 S100B 样本纳入模型（OR=15.5；p=0.009）。对该组进行受试者工作特征（ROC）曲线分析，显示 24 小时 S100B 测定的曲线下面积（AUC）最高（0.86；p=0.001）。截断值设定为 0.372μg/L（85.7%的灵敏度，79.3%的特异性，阳性预测值[PPV]=18.7%和阴性预测值[NPV]=98.9%）。本研究表明，入院时的瞳孔反应性以及 24 小时血清 S100B 水平可作为严重 TBI 后 BD 风险患者早期检测的筛查工具。
