Zarei Hamed, Roshdi Dizaji Shayan, Toloui Amirmohammad, Yousefifard Mahmoud, Esmaeili Alireza
Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Both authors contributed equally to this work.
Arch Acad Emerg Med. 2024 Feb 18;12(1):e29. doi: 10.22037/aaem.v12i1.2222. eCollection 2024.
Traumataic brain injury (TBI) represents a significant global health burden. This systematic review delves into the comparison of S100B and Neuron-Specific Enolase (NSE) regarding their diagnostic and prognostic accuracy in TBI within the adult population.
Conducted on October 21, 2023, the search identified 24 studies encompassing 6454 adult patients. QUADAS-2 and QUAPAS tools were employed to assess the risk of bias. The analyses aimed to evaluate the diagnostic and prognostic performance of S100B and NSE based on sensitivity, specificity, and area under the curve (AUC). The outcomes were detecting intracranial injury, mortality, and unfavorable outcome.
Pooled data analysis tended towards favoring S100B for diagnostic and prognostic purposes. S100B exhibited a diagnostic AUC of 0.74 (95% confidence interval (CI): 0.70-0.78), sensitivity of 80% (95% CI: 63%-90%), and specificity of 59% (95% CI: 45%-72%), outperforming NSE with an AUC of 0.66 (95% CI: 0.61-0.70), sensitivity of 74% (95% CI: 53%-88%), and specificity of 46% (95% CI: 24%-69%). Notably, both biomarkers demonstrated enhanced diagnostic value when blood samples were collected within 12 hours post-injury. The analyses also revealed the excellent diagnostic ability of S100B with a sensitivity of 99% (95% CI: 4%-100%) and a specificity of 76% (95% CI: 51%-91%) in mild TBI patients (AUC = 0.89 [0.86-0.91]). In predicting mortality, S100B showed a sensitivity of 90% (95% CI: 65%-98%) and specificity of 61% (95% CI: 39%-79%), slightly surpassing NSE's performance with a sensitivity of 88% (95% CI: 76%-95%) and specificity of 56% (95% CI: 47%-65%). For predicting unfavorable outcomes, S100B exhibited a sensitivity of 83% (95% CI: 74%-90%) and specificity of 51% (95% CI: 30%-72%), while NSE had a sensitivity of 80% (95% CI: 64%-90%) and specificity of 59% (95% CI: 46%-71%).
Although neither biomarker has shown promising diagnostic performance in detecting abnormal computed tomography (CT) findings, they have displayed acceptable outcome prediction capabilities, particularly with regard to mortality.
创伤性脑损伤（TBI）是一项重大的全球健康负担。本系统评价深入探讨了S100B和神经元特异性烯醇化酶（NSE）在成年人群TBI诊断和预后准确性方面的比较。
于2023年10月21日进行检索，共识别出24项研究，涵盖6454例成年患者。采用QUADAS - 2和QUAPAS工具评估偏倚风险。分析旨在基于敏感性、特异性和曲线下面积（AUC）评估S100B和NSE的诊断和预后性能。结果指标为检测颅内损伤、死亡率和不良结局。
汇总数据分析倾向于支持S100B用于诊断和预后目的。S100B的诊断AUC为0.74（95%置信区间（CI）：0.70 - 0.78），敏感性为80%（95% CI：63% - 90%），特异性为59%（95% CI：45% - 72%），优于NSE，NSE的AUC为0.66（95% CI：0.61 - 0.70），敏感性为74%（95% CI：53% - 88%），特异性为46%（95% CI：24% - 69%）。值得注意的是，当在伤后12小时内采集血样时，两种生物标志物的诊断价值均有所提高。分析还显示，S100B在轻度TBI患者中具有出色的诊断能力，敏感性为99%（95% CI：4% - 100%），特异性为76%（95% CI：51% - 91%）（AUC = 0.89 [0.86 - 0.91]）。在预测死亡率方面，S100B的敏感性为90%（95% CI：65% - 98%），特异性为61%（95% CI：39% - 79%），略优于NSE，NSE的敏感性为88%（95% CI：76% - 95%），特异性为56%（95% CI：47% - 65%）。对于预测不良结局，S100B的敏感性为83%（95% CI：74% - 90%），特异性为51%（95% CI：30% - 72%），而NSE的敏感性为80%（95% CI：64% - 90%），特异性为59%（95% CI：46% - 71%）。
尽管两种生物标志物在检测计算机断层扫描（CT）异常结果方面均未显示出有前景的诊断性能，但它们展现出了可接受的结局预测能力，尤其是在死亡率方面。
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