The association of ICP, CPP, CT findings and the levels of S-100B and NSE in severe traumatic head injury. Prognostic value of the biomarkers.
(English)Manuscript (preprint) (Other academic)
The first hypothesis was that biochemical markers of brain injury might be influenced by the intracranial pressure (ICP) and cerebral perfusion pressure (CPP) after severe traumatic brain injury (sTBI), in patients treated by an ICP targeted therapy. A second hypothesis was that there is a relationship between the biomarker levels and a systematic classification of the CT-scan of the brain. We also hypothesized that clinical outcome can be related to biomarker levels and that mortality may be predicted by the biomarkers. In this prospective consecutive study patients with sTBI were included. Inclusion criteria were Glasgow Coma Scale (GCS) score ≤ 8, age between 15 and 70 years, an initial cerebral perfusion pressure >10 mm Hg. Blood samples for neuron specific enolase (NSE) and S-100B were collected twice daily during five consecutive days. The initial (CTinit) and follow-up CT-scans (CT24h) were classified according to the Marshall, Rotterdam and Morris-Marshall classifications. Outcome was evaluated with extended Glasgow outcome scale (GOSE) at 3 months. There was a clear correlation of the maximal ICP (ICPmax) and minimal CPP (CPPmin) with the S-100B and NSE levels. A complex relation between biomarkers and the CT classifications were observed. Generally, the Marshall scores were correlated to the biomarker levels at 72 hrs and the Rotterdam scores correlated to the total (bulk) release. The Morris-Marshall scores correlated to all S-100B values, but not to any of the NSE values. A ROC curve analysis showed that the biomarkers had a moderate predictive value of mortality. S-100B bulk release and NSE at 72 hrs had the highest power in this prediction. A combination of the CT classification according to Morris-Marshall and the bulk release of S-100B further improved the prediction of clinical outcome.
Research subject Neurosurgery
IdentifiersURN: urn:nbn:se:umu:diva-85843OAI: oai:DiVA.org:umu-85843DiVA: diva2:695524