title: Prognostic value of brain injury biomarkers in acute encephalitis/encephalopathy.
abstract: BACKGROUND
  Acute encephalitis/encephalopathy (AEE) is a devastating cause of severe neurodevelopmental sequelae or death in children. Assessing ongoing brain injury and predicting outcomes using bedside point-of-care testing is expected to be extremely valuable.
  
  
  METHODS
  For this study, three brain injury markers, S-100B, glial fibrillary acidic protein (GFAP), and tau protein, were measured in early cerebrospinal fluid samples of children with AEE. Subjects comprised three groups: Group 1 (non-AEE control, n = 27); Group 2 (AEE with normal resolution or mild sequelae, n = 13); and Group 3 (AEE with severe sequelae or death, i.e. "poor outcome," n = 10).
  
  
  RESULTS
  All marker levels were significantly higher in Group 3 than in Group 1 or 2. In Group 3, only S-100B was significantly higher in non-survivors than in survivors. For scoring assessment (range: 0-3 points), the predictive accuracies of 3 points for poor outcomes in children with AEE (i.e. Group 2 and 3, n = 23) were 91% (21/23) for S-100B, 74% (17/23) for GFAP, and 78% (18/23) for tau. When the scores were summed up for S-100B, GFAP, and tau (range: 0-9 points), and for S-100B and tau (range: 0-6 points), the patients with poor outcomes were identified more accurately using the respective thresholds of 6 points and 4 points (96% [22/23] and 100% [23/23], respectively).
  
  
  CONCLUSIONS
  Our findings suggest that combined measurement and scoring assessment of the markers, especially S-100B and tau, show promise as predictors of clinical outcomes in children with AEE.
authors.affiliation: Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. hirokazu010661@yahoo.co.jp
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Tsukahara
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Fujii
authors.forename: Kousaku
authors.initials: K
authors.lastname: Matsubara
authors.forename: Mutsuko
authors.initials: M
authors.lastname: Yamada
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Nagaoka
authors.forename: Yukie
authors.initials: Y
authors.lastname: Saito
authors.forename: Masato
authors.initials: M
authors.lastname: Yashiro
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Tsuge
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Goto
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Kitamura
authors.forename: Atsuko
authors.initials: A
authors.lastname: Hata
authors.forename: Takashi
authors.initials: T
authors.lastname: Ichiyama
authors.forename: Tsuneo
authors.initials: T
authors.lastname: Morishima
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000134:cerebrospinal fluid; D002648:Child; D002675:Child, Preschool; D004660:Encephalitis / Q000134:cerebrospinal fluid*; D005260:Female; D005500:Follow-Up Studies; D005904:Glial Fibrillary Acidic Protein / Q000134:cerebrospinal fluid*; D006801:Humans; D007223:Infant; D008297:Male; D009414:Nerve Growth Factors / Q000134:cerebrospinal fluid*; D011379:Prognosis; D015203:Reproducibility of Results; D009418:S100 Proteins / Q000134:cerebrospinal fluid*; D012720:Severity of Illness Index; D016875:tau Proteins / Q000134:cerebrospinal fluid*
chemical_list: D015415:Biomarkers; D005904:Glial Fibrillary Acidic Protein; D009414:Nerve Growth Factors; D009418:S100 Proteins; D016875:tau Proteins
keywords: S-100B protein; acute encephalitis/encephalopathy; cerebrospinal fluid; glial fibrillary acidic protein; tau protein