S100B protein may detect brain death development after severe traumatic brain injury

Area of Science:

• Neuroscience
• Critical Care Medicine
• Transplant Surgery

Background:

• Declining organ donor rates in developed countries necessitate improved methods for identifying potential donors.
• Early detection of patients at risk for brain death (BD) is a priority for transplant teams.
• S100B protein is a known biomarker for traumatic brain injury (TBI), but its prognostic value for predicting BD is unexplored.

Purpose of the Study:

• To assess the utility of acute S100B levels, alongside standard clinical data, as an early screening tool for BD after severe TBI.
• To evaluate S100B's prognostic capacity in predicting BD in patients with severe TBI.

Main Methods:

• Prospective study of 140 patients with severe TBI (Glasgow Coma Scale score ≤ 8) admitted to a Neurocritical Care Unit.
• Collected clinical variables including GCS, pupillary response, hypotension, desaturation, CT findings, ISS, and serum S100B levels at admission and 24 hours post-admission.
• Utilized multivariate analysis and Receiver Operating Characteristic (ROC) curve analysis to determine the predictive value of S100B for BD.

Main Results:

• Patients who developed BD had significantly higher S100B concentrations (p<0.001).
• Bilateral unresponsive mydriasis and 24-hour S100B levels were significant predictors of BD (ORs 21.35 and 4.9, respectively).
• In patients with initial pupillary reflex, 24-hour S100B was the sole predictor (OR=15.5), with an AUC of 0.86 for BD prediction.

Conclusions:

• Pupillary responsiveness upon admission and 24-hour serum S100B levels can serve as effective screening tools for early BD risk detection in severe TBI patients.
• This approach can aid in the more efficient identification of potential organ donors.
• S100B measurement at 24 hours post-TBI shows significant prognostic value for brain death prediction.