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.

Materials and 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).

Conclusion: 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.

• CPP
• CT classification
• ICP targeted therapy
• ICP
• NSE
• prognostication
• S-100B
• severe traumatic brain injury

Acknowledgement

We acknowledge the staff at the intensive care unit and neurosurgical department, our research nurses Kristin Nyman and Anna-Lena Östlund and our colleagues Magnus Olivecrona, MD, PhD, Assistant Professor Silvana Naredi, MD, PhD, and Marie Rodling-Wahlström, MD, PhD. Special thanks to Ann-Margret Kallberg at Sangtech Medical for assistance with the analysis of the biomarkers.

Declaration of interest

The authors report no conflicts of interest. Financial support from the Department of Pharmacology and Clinical Neuroscience, Umeå University, Tore Nilsson Found, Kempe Found, and Capio Research Found is acknowledged.