Departement of Anaesthesiology and Intensive Care Medicine AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria; Department of Anesthesiology and Critical Care Medicine, Medical University, Innsbruck, Austria.
Departement of Anaesthesiology and Intensive Care Medicine AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria; Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Trauma Research Centre, Vienna, Austria.
Injury. 2024 Jan;55(1):111187. doi: 10.1016/j.injury.2023.111187. Epub 2023 Nov 7.
S100 B is an extensively studied neuro-trauma marker, but its specificity and subsequently interpretation in major trauma patients might be limited, since extracerebral injuries are known to increase serum levels. Thus, we evaluated the potential role of S100B in the assessment of severe traumatic brain injury (TBI) in multiple injured patients upon emergency room (ER) admission and the first days of intensive care unit (ICU) stay.
Retrospective study employing trauma registry data derived from a level 1 trauma center. Four cohorts of patients were grouped: isolated TBI (iTBI), polytrauma patients with TBI (PT + TBI), polytrauma patients without TBI (PT-TBI) and patients without polytrauma or TBI (control). S100B-serum levels were assessed immediately after admission in the emergency room and during the subsequent ICU stay. Values were correlated with injury severity score (ISS), Glasgow Coma Score (GCS) and in-hospital mortality.
780 predominantly male patients (76 %) with a median age of 48 (30-63) and a median ISS of 24 (17-30) were enrolled in the study. Admission S100B correlated with ISS and TBI severity defined by the GCS (both p < 0.0001) but not with head abbreviated injury score (AIS) (p = 0.38). Compared with survivors, non-survivors had significantly higher median S100B levels in the ER (6.14 μg/L vs. 2.06 μg/L; p < 0.0001) and at ICU-day 1 (0.69 μg/L vs. 0.17 μg/L; p < 0.0001). S100B in the ER predicted mortality with an area under curve (AUC) of 0.77 (95 % CI 0,70-0,83, p < 0.0001), vs. 0.86 at ICU-day 1 (95 % CI 0,80-0,91, p < 0.0001).
In conclusion, S100B is a valid biomarker for prediction of mortality in major trauma patients with a higher accuracy when assessed at the first day of ICU stay vs. immediately after ER admission. Since S100B did not correlate with pathologic TBI findings in multiple injured patients, it failed as predictive neuro-marker because extracerebral injuries demonstrated a higher influence on admission levels than neurotrauma. Although S100B levels are indicative for injury severity they should be interpreted with caution in polytrauma patients.
S100B 是一种广泛研究的神经创伤标志物，但在接受急诊室（ER）治疗的严重创伤患者中，其特异性和解释可能受到限制，因为已知颅外损伤会增加血清水平。因此，我们评估了 S100B 在评估多发性创伤患者严重创伤性脑损伤（TBI）时的潜在作用。在急诊室就诊时和入住重症监护病房（ICU）后的最初几天内。
采用来自 1 级创伤中心的创伤登记数据进行回顾性研究。将患者分为四组：单纯性 TBI（iTBI）、合并 TBI 的多发伤患者（PT+TBI）、无 TBI 的多发伤患者（PT-TBI）和无多发伤或 TBI 的患者（对照组）。入院时在急诊室和随后的 ICU 期间评估 S100B 血清水平。对损伤严重程度评分（ISS）、格拉斯哥昏迷评分（GCS）和院内死亡率进行了相关性分析。
780 名主要为男性（76%）患者，年龄中位数为 48（30-63）岁，ISS 中位数为 24（17-30）岁。入院 S100B 与 ISS 和 GCS 定义的 TBI 严重程度相关（均 p<0.0001），但与头部简短损伤评分（AIS）无关（p=0.38）。与幸存者相比，非幸存者在急诊室（6.14μg/L 比 2.06μg/L；p<0.0001）和 ICU 第 1 天（0.69μg/L 比 0.17μg/L；p<0.0001）的中位 S100B 水平明显更高。急诊室 S100B 预测死亡率的曲线下面积（AUC）为 0.77（95%CI 0.70-0.83，p<0.0001），而 ICU 第 1 天为 0.86（95%CI 0.80-0.91，p<0.0001）。
总之，S100B 是预测严重创伤患者死亡率的有效生物标志物，在 ICU 入住第 1 天评估时的准确性高于急诊室入院时。由于 S100B 与多发伤患者的病理性 TBI 发现无关，因此作为预测性神经标志物失败，因为颅外损伤对入院水平的影响高于神经创伤。尽管 S100B 水平表明损伤严重程度，但在多发伤患者中应谨慎解释。
