GFAP and S100B are biomarkers of traumatic brain injury: An observational cohort study

• Published in: Neurology Vol. 75; no. 20; pp. 1786 - 1793
• Main Authors: VOS, P. E, JACOBS, B, ANDRIESSEN, T. M. J. C, LAMERS, K. J. B, BORM, G. F, BEEMS, T, EDWARDS, M, ROSMALEN, C. F, VISSERS, J. L. M
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 16-11-2010
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Biomarkers - blood; Brain Injuries - blood; Brain Injuries - diagnosis; Brain Injuries - mortality; Cohort Studies; Diagnostic Tests, Routine; Emergency Service, Hospital; Female; Glial Fibrillary Acidic Protein - blood; Humans; Injuries of the nervous system and the skull. Diseases due to physical agents; Male; Medical sciences; Middle Aged; Nerve Growth Factors - blood; Neurology; Predictive Value of Tests; S100 Calcium Binding Protein beta Subunit; S100 Proteins - blood; Traumas. Diseases due to physical agents; Young Adult; Nervous system diseases; Cohort study; Head trauma
• ISSN: 0028-3878; 1526-632X
• DOI: 10.1212/WNL.0b013e3181fd62d2

Biomarker levels in blood after traumatic brain injury (TBI) may offer diagnostic and prognostic tools in addition to clinical indices. This study aims to validate glial fibrillary acidic protein (GFAP) and S100B concentrations in blood as outcome predictors of TBI using cutoff levels of 1.5 μg/L for GFAP and 1.13 μg/L for S100B from a previous study.
In 79 patients with TBI (Glasgow Coma Scale score [GCS] ≤12), serum, taken at hospital admission, was analyzed for GFAP and S100B. Data collected included injury mechanism, age, gender, mass lesion on CT, GCS, pupillary reactions, Injury Severity Score (ISS), presence of hypoxia, and hypotension. Outcome was assessed, using the Glasgow Outcome Scale Extended (dichotomized in death vs alive and unfavorable vs favorable), 6 months post injury.
In patients who died compared to alive patients, median serum levels were increased: GFAP 33.4-fold and S100B 2.1-fold. In unfavorable compared to favorable outcome, GFAP was increased 19.8-fold and S100B 2.1-fold. Univariate logistic regression analysis revealed that mass lesion, GFAP, absent pupils, age, and ISS, but not GCS, hypotension, or hypoxia, predicted death and unfavorable outcome. Multivariable analysis showed that models containing mass lesion, pupils, GFAP, and S100B were the strongest in predicting death and unfavorable outcome. S100B was the strongest single predictor of unfavorable outcome with 100% discrimination.
This study confirms that GFAP and S100B levels in serum are adjuncts to the assessment of brain damage after TBI and may enhance prognostication when combined with clinical variables.