Yin W, Weng S, Lai S, Nie H
Department of Emergency Medicine, West China Hospital, Sichuan University, Chengdu 610041, China.
Department of Intensive Care Medicine, Panzhihua Municipal Central Hospital, Panzhihua 617067, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2021 Apr 20;41(4):543-548. doi: 10.12122/j.issn.1673-4254.2021.04.09.
To explore the value of Glasgow Coma Scale (GCS) score and CT score combined with serum S100B protein level for evaluation of injury severity and predicting early prognosis of acute traumatic brain injury (TBI).
A total of 108 patients with TBI admitted within 24 h after injury in the Emergency Department of West China Hospital from May, 2019 to May, 2020 were enrolled in this study. The clinical data, laboratory test results, CT examination, GCS score, Full Outline of Unresponsiveness score, Fisher CT classification, Rotterdam CT score, and serum S100B protein level of the patients were collected upon admission. The patients were followed up for 28 days and divided based on their Glasgow Outcome Scale (GOS) scores into poor prognosis group (GOS 1-3) and good prognosis group (GOS 4-5). The indexes related to poor prognosis were analyzed for their efficacy for predicting the patinets' prognosis. According to the results of head CT, the patients were divided into CT positive (CT) group and CT negative (CT) group, and the efficacy of serum S100B protein level for predicting CT positivity was evaluated.
Compared with those with favorable prognosis, the patients with poor prognosis had significantly lower GCS scores ( < 0.01) and higher Rotterdam CT score and serum S100B protein levels ( < 0.01). Among the 3 index, serum S100B protein level had the highest AUC value (0.79); among the combined indexes, GCS score combined with serum S100B protein had the highest AUC value (0.80). Serum S100B protein level was significantly higher in CT group than in CT - group ( < 0.05) with a significant correlation with Rotterdam CT score (=0.26, < 0.01).
Serum S100B protein level, GCS score, and Rotterdam CT score can be used as indicators for evaluating the severity of acute TBI, and they are all closely related with early prognosis of the patients. The combination of serum S100B protein, GCS score and Rotterdam CT score has better performance than any of the 3 indexes alone for predicting early prognosis of the patients. Serum S100B protein level is correlated with head imaging findings of patients with acute TBI, but its value in selection of appropriate imaging modalities awaits further investigation.
探讨格拉斯哥昏迷量表（GCS）评分、CT评分联合血清S100B蛋白水平对评估急性创伤性脑损伤（TBI）严重程度及预测早期预后的价值。
选取2019年5月至2020年5月在四川大学华西医院急诊科伤后24小时内入院的108例TBI患者。收集患者入院时的临床资料、实验室检查结果、CT检查、GCS评分、全面无反应性评分、Fisher CT分级、鹿特丹CT评分及血清S100B蛋白水平。对患者进行28天随访，根据格拉斯哥预后量表（GOS）评分分为预后不良组（GOS 1 - 3）和预后良好组（GOS 4 - 5）。分析与预后不良相关的指标对患者预后的预测效能。根据头颅CT结果将患者分为CT阳性（CT）组和CT阴性（CT）组，评估血清S100B蛋白水平对预测CT阳性的效能。
与预后良好的患者相比，预后不良的患者GCS评分显著更低（<0.01），鹿特丹CT评分及血清S100B蛋白水平更高（<0.01）。在这3项指标中，血清S100B蛋白水平的曲线下面积（AUC）值最高（0.79）；在联合指标中，GCS评分联合血清S100B蛋白的AUC值最高（0.80）。CT组血清S100B蛋白水平显著高于CT -组（<0.05），且与鹿特丹CT评分显著相关（=0.26，<0.01）。
血清S100B蛋白水平、GCS评分及鹿特丹CT评分可作为评估急性TBI严重程度的指标，且均与患者早期预后密切相关。血清S100B蛋白、GCS评分和鹿特丹CT评分联合应用在预测患者早期预后方面比单独使用这3项指标中的任何一项表现更好。血清S100B蛋白水平与急性TBI患者的头颅影像学表现相关，但其在选择合适影像学检查方式中的价值有待进一步研究。
