Service of Intensive Care, Marqués de Valdecilla University Hospital, IDIVAL, Avda. Valdecilla, s/n 39008, Santander, Spain.
Service of Inmunology, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, Avda Valdecilla, s/n 39008, Santander, Cantabria, Spain.
J Neurol Sci. 2018 Feb 15;385:109-114. doi: 10.1016/j.jns.2017.12.017. Epub 2017 Dec 18.
AIMS/BACKGROUND: To evaluate the correlation between protein S100B concentrations measured in the jugular bulb as well as at peripheral level and the prognostic usefulness of this marker.
A prospective study of all patients admitted to the intensive care unit with acute brain damage was carried out. Peripheral and jugular bulb blood samples were collected upon admission and every 24h for three days. The endpoints were brain death diagnosis and the Glasgow Outcome Scale score after 6months.
A total of 83 patients were included. Jugular protein S100B levels were greater than systemic levels upon admission and also after 24 and 72h (mean difference>0). Jugular protein S100B levels showed acceptable precision in predicting brain death both upon admission [AUC 0.67 (95% CI 0.53-0.80)] and after 48h [AUC 0.73 (95% CI 0.57-0.89)]. Similar results were obtained regarding the capacity of jugular protein S100B levels upon admission to predict an unfavourable outcome (AUC 0.69 (95% CI 0.56-0.79)). The gradient upon admission (jugular-peripheral levels) showed its capacity to predict the development of brain death [AUC 0.74 (95% CI 0.62-0.86)] and together with the Glasgow Coma Scale constituted the independent factors associated with the development of brain death.
Regional protein S100B determinations are higher than systemic determinations, thus confirming the cerebral origin of protein S100B. The transcranial protein S100B gradient is correlated to the development of brain death.
目的/背景：评估颈静脉球和外周血中 S100B 蛋白浓度与该标志物预后价值之间的相关性。
对所有因急性脑损伤而入住重症监护病房的患者进行前瞻性研究。入院时及入院后 3 天内每 24 小时采集外周血和颈静脉球血样本。终点是脑死亡诊断和 6 个月后的格拉斯哥预后评分。
共纳入 83 例患者。入院时，颈静脉球 S100B 蛋白水平高于全身水平，24 小时和 72 小时后仍如此（平均差值>0）。入院时 [AUC 0.67（95%CI 0.53-0.80)] 和 48 小时后 [AUC 0.73（95%CI 0.57-0.89)]，颈静脉球 S100B 水平预测脑死亡的准确性均尚可。入院时颈静脉球 S100B 水平预测不良预后的结果也类似（AUC 0.69（95%CI 0.56-0.79））。入院时的梯度（颈静脉球与外周血水平的差值）显示其有预测脑死亡发生的能力 [AUC 0.74（95%CI 0.62-0.86)]，与格拉斯哥昏迷评分一起构成了与脑死亡发生相关的独立因素。
局部 S100B 蛋白测定值高于全身测定值，证实了 S100B 蛋白的脑源性。颅 S100B 蛋白梯度与脑死亡的发生相关。
