GFAP versus S100B in serum after traumatic brain injury: relationship to brain damage and outcome.
Research indicates that glial fibrillary acidic protein (GFAP), part of the astroglial skeleton, could be a marker of traumatic brain injury (TBI). S100B, an astroglial protein, is an acknowledged marker of TBI. Our goal was to analyze the relationship of GFAP/S100B to brain damage and outcome, and to compare the accuracy of GFAP/S100B for prediction of mortality after TBI. Our prospective study included 92 patients admitted <12 h after TBI (median injury severity score 25, median Glasgow Coma Scale 6). TBI was verfied by computerized tomography. GFAP/S100B were measured immunoluminometrically at admission and daily in the intensive care unit (average 10 days, range 1-21 days). We compared GFAP/S100B in non-survivors versus survivors, accuracy for mortality prediction according to receiver operated characteristic curve analysis, correlation between GFAP and S100B, relationship of GFAP/S100B to computerized tomography, cerebral perfusion pressure (CPP), mean arterial pressure (MAP) and 3-month Glasgow Outcome Score (GOS). GFAP (p < 0.005) and S100B (p < 0.0005) were higher in non-survivors than survivors. Both GFAP and S100B were accurate for mortality prediction (area under curve 0.84 versus 0.78 at <12 h after TBI). GFAP and S100B release correlated better later than 36 h after TBI (r = 0.75) than earlier (r = 0.58). GFAP was lower in focal lesions of <25 mL than in shifts of >0.5 cm (p < 0.0005) and non-evacuated mass lesions of >25 mL (p < 0.005). S100B was lower in focal lesions of <25 mL than in non-evacuated mass lesions (p < 0.0005) and lower in swelling than in shifts of >0.5 cm (p < 0.005). GFAP and S100B were lower in ICP < 25 than ICP > or = 25 (p < 0.0005), in CPP > or = 60 than CPP < 60 (p < 0.0005), in MAP > 70 than MAP < or = 70 mm Hg, and in GOS 4-5 than GOS 1 (p < 0.0005). Both measurement of GFAP and S100B is a useful non-invasive means of identifying brain damage with some differences based on the pattern of TBI and accompanying multiple trauma and/or shock.
Pelinka
Linda E
LE
Ludwig Boltzmann Institute for Experimental and Clinical Traumatology and Research Unit of the Austrian Workers' Compensation Board (AUVA), Vienna, Austria. lindapel@via.at
Kroepfl
Alfred
A
Leixnering
Martin
M
Buchinger
Walter
W
Raabe
Andreas
A
Redl
Heinz
H
D000328:Adult; D001253:Astrocytes / Q000378:metabolism; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000502:physiology; D001921:Brain / Q000000981:diagnostic imaging / Q000378:metabolism*; D001930:Brain Injuries / Q000097:blood* / Q000175:diagnosis* / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000502:physiology; D003128:Coma / Q000097:blood / Q000209:etiology / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D023261:Glasgow Outcome Scale / Q000706:statistics & numerical data; D005904:Glial Fibrillary Acidic Protein / Q000097:blood*; D005911:Gliosis / Q000097:blood / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009414:Nerve Growth Factors; D011237:Predictive Value of Tests; D012372:ROC Curve; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins / Q000097:blood*; D015996:Survival Rate; D014057:Tomography, X-Ray Computed
D015415:Biomarkers; D005904:Glial Fibrillary Acidic Protein; D009414:Nerve Growth Factors; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins; C579160:S100B protein, human