title: Association of ICP, CPP, CT findings and S-100B and NSE in severe traumatic head injury. Prognostic value of the biomarkers.
abstract: OBJECTIVE
  The association was studied of intracranial pressure (ICP) and cerebral perfusion pressure (CPP) on S-100B and neuron-specific enolase (NSE) in severe traumatic brain injury (sTBI). The relationship was explored between biomarkers, ICP, CPP, CT-scan classifications and the clinical outcome.
  
  
  METHODS
  Data were collected prospectively and consecutively in 48 patients with Glasgow Coma Scale score ≤ 8, age 15-70 years. NSE and S-100B were analysed during 5 consecutive days. The initial and follow-up CT-scans were classified according to the Marshall, Rotterdam and Morris-Marshall classifications. Outcome was evaluated with extended Glasgow outcome scale at 3 months.
  
  
  RESULTS
  Maximal ICP and minimal CPP correlated with S-100B and NSE levels. Complex relations between biomarkers and CT classifications were observed. S-100B bulk release (AUC = 0.8333, p = 0.0009), and NSE at 72 hours (AUC = 0.8476, p = 0.0045) had the highest prediction power of mortality. Combining Morris-Marshall score and S-100B bulk release improved the prediction of clinical outcome (AUC = 0.8929, p = 0.0008).
  
  
  CONCLUSIONS
  Biomarker levels are associated with ICP and CPP and reflect different aspects of brain injury as evaluated by CT-scan. The biomarkers might predict mortality. There are several pitfalls influencing the interpretation of biomarker data in respect to ICP, CPP, CT-findings and clinical outcome.
authors.affiliation: Institution of Pharmacology and Clinical Neuroscience, Department of Neurosurgery, Umeå University , Umeå , Sweden.
authors.forename: Zandra
authors.initials: Z
authors.lastname: Olivecrona
authors.forename: Lukas
authors.initials: L
authors.lastname: Bobinski
authors.forename: Lars-Owe D
authors.initials: LO
authors.lastname: Koskinen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001930:Brain Injuries / Q000097:blood* / Q000503:physiopathology*; D002560:Cerebrovascular Circulation / Q000502:physiology; D005260:Female; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D010751:Phosphopyruvate Hydratase / Q000097:blood*; D011379:Prognosis; D064568:S100 Calcium Binding Protein beta Subunit / Q000097:blood*; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D015415:Biomarkers; D064568:S100 Calcium Binding Protein beta Subunit; C579160:S100B protein, human; D010751:Phosphopyruvate Hydratase
keywords: CPP; CT classification; ICP; ICP targeted therapy; NSE; S-100B; prognostication; severe traumatic brain injury