Journal Article

GFAP Versus S100B in Serum after Traumatic Brain Injury: Relationship to Brain Damage and Outcome

Redl, Heinz, Kroepfl, Alfred, Leixnering, Martin, Raabe, Andreas, Pelinka, Linda E., Buchinger, Walter

2004

Overview

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 ≥ 25 (p < 0.0005), in CPP ≥ 60 than CPP < 60 (p < 0.0005), in MAP > 70 than MAP ≤ 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.

• Publisher: SAGE Publications,Liebert,Mary Ann Liebert, Inc
• Subject: Adult / Astrocytes - metabolism / Biological and medical sciences / Biomarkers - blood / Blood Pressure - physiology / Brain - diagnostic imaging / Brain - metabolism / Brain Injuries - blood / Brain Injuries - diagnosis / Brain Injuries - physiopathology / Cerebrovascular Circulation - physiology / Coma - blood / Coma - etiology / Coma - physiopathology / Disease Progression / Female / Glasgow Outcome Scale - statistics & numerical data / Glial Fibrillary Acidic Protein - blood / Gliosis - blood / Gliosis - physiopathology / Humans / Injuries of the nervous system and the skull. Diseases due to physical agents / Male / Medical sciences / Middle Aged / Nerve Growth Factors / Predictive Value of Tests / ROC Curve / S100 Calcium Binding Protein beta Subunit / S100 Proteins - blood / Survival Rate / Tomography, X-Ray Computed / Traumas. Diseases due to physical agents