title: Serum S100B protein is increased and correlates with interleukin 6, hypoperfusion indices, and outcome in patients admitted for surgical control of hemorrhage.
abstract: S100B protein, an acknowledged biomarker of brain injury, has been reported to be increased in hemorrhagic shock. Also, acute hemorrhage is associated with inflammatory response. The aim of this study was to investigate the concentrations of serum S100B and the potential relationships with interleukin 6 (IL-6), severity of tissue hypoperfusion, and prognosis in patients admitted for surgical control of severe hemorrhage. Patients undergoing elective abdominal aortic aneurysm surgery participated as control subjects. Serum samples were drawn before, at the end of surgery, and after 6 and 24 h. Sixty-four patients with severe hemorrhage (23 trauma and 41 nontrauma) and 17 control subjects were included. Increased preoperative concentrations of S100B protein (1.70 ± 2.13 and 0.81 ± 1.23 μg/L) and IL-6 (241 ± 291 and 226 ± 238 pg/mL) were found in patients with traumatic and nontraumatic reason, respectively, and remained elevated throughout 24 h. Compared with nontrauma, trauma patients exhibited higher preoperative S100B levels (P < 0.05). Overall mortality was 47%. In control subjects, preoperative S100B and IL-6 levels were within normal limits and increased at the end of surgery (P < 0.001 and P < 0.01, respectively). Preoperative S100B correlated with IL-6 (r = 0.78, P < 0.01), arterial lactate (r = 0.50, P < 0.01), pH (r = -0.45, P < 0.01), and bicarbonate (r = -0.40, P < 0.01). Multiple analysis revealed that preoperative S100B in trauma and lactate in nontrauma patients were independently associated with outcome. In predicting death, preoperative S100B yielded receiver operator characteristics curve areas of 0.75 for all patients and 0.86 for those with trauma. These results indicate that severe hemorrhage in patients without brain injury is associated with increased serum levels of S100B, which correlates with IL-6 and tissue hypoperfusion. Moreover, the predictive ability of S100B for mortality, suggests that it could be a marker of potential clinical value in identifying, among patients with severe hemorrhage, those at greater risk for adverse outcome.
authors.affiliation: *Department of Anesthesiology, †First Department of Critical Care, Medical School, University of Athens, and ‡Biochemical Laboratory, Evangelismos Hospital, Athens, Greece.
authors.forename: Elisavet
authors.initials: E
authors.lastname: Stamataki
authors.forename: Anastasios
authors.initials: A
authors.lastname: Stathopoulos
authors.forename: Eleanna
authors.initials: E
authors.lastname: Garini
authors.forename: Stelios
authors.initials: S
authors.lastname: Kokkoris
authors.forename: Constantinos
authors.initials: C
authors.lastname: Glynos
authors.forename: Christina
authors.initials: C
authors.lastname: Psachoulia
authors.forename: Harikleia
authors.initials: H
authors.lastname: Pantziou
authors.forename: Serafeim
authors.initials: S
authors.lastname: Nanas
authors.forename: Christina
authors.initials: C
authors.lastname: Routsi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery; D001639:Bicarbonates / Q000097:blood; D015415:Biomarkers / Q000097:blood; D005260:Female; D006470:Hemorrhage / Q000401:mortality / Q000601:surgery*; D006801:Humans; D015850:Interleukin-6 / Q000097:blood*; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D064568:S100 Calcium Binding Protein beta Subunit / Q000097:blood*; D016896:Treatment Outcome
chemical_list: D001639:Bicarbonates; D015415:Biomarkers; D015850:Interleukin-6; D064568:S100 Calcium Binding Protein beta Subunit; C579160:S100B protein, human; D019344:Lactic Acid