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Association of ICP, CPP, CT findings and S-100B and NSE in severe traumatic head injury. Prognostic value of the biomarkers
Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience.
Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
2015 (English)In: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 29, no 4, 446-454 p.Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
2015. Vol. 29, no 4, 446-454 p.
Keyword [en]
CPP, CT classification, ICP targeted therapy, ICP, NSE, prognostication, S-100B, severe traumatic brain jury
National Category
URN: urn:nbn:se:umu:diva-103228DOI: 10.3109/02699052.2014.989403ISI: 000352803300005PubMedID: 25518864OAI: diva2:812484
Available from: 2015-05-19 Created: 2015-05-18 Last updated: 2016-07-13Bibliographically approved
In thesis
1. On evolution of intracranial changes after severe traumatic brain injury and its impact on clinical outcome
Open this publication in new window or tab >>On evolution of intracranial changes after severe traumatic brain injury and its impact on clinical outcome
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Severe traumatic brain injury (sTBI) is a cause of death and disability worldwide and requires treatment at specialized neuro-intensive care units (NICU) with a multimodal monitoring approach. The CT scan imaging supports the monitoring and diagnostics. The level of S100B and neuron specific enolase (NSE) reflects the severity of the injury. The therapy resistant intracranial hypertension requires decompressive craniectomy (DC). After DC, the cranium must be reconstructed to recreate the normal intracranial physiology as well as to address cosmetic issues. The evolution of the pathological intracranial changes was analyzed in accordance with the three CT classifications: Marshall, Rotterdam and Morris-Marshall. The Rotterdam scale was best in describing the dynamics of the pathological evolution. Both the Rotterdam score and Morris- Marshall classification showed strong correlation with the clinical outcome, a finding that suggests that they could be used for prognostication. We demonstrated a clear correlation between the CT classifications and concentrations of S100B and NSE. The results revealed a concomitant correlation between NSE and S100B and clinical outcome. We found that the interaction between the ICP, Rotterdam CT classification, and concentrations of biochemical biomarkers are all associated with DC. We found a high percentage of complications following cranioplasty. Our results call into question whether custom-made allograft should be considered the best material for cranioplasty. It is concluded that both the Rotterdam and Morris-Marshall classification contribute to clinical evaluation of intracranial dynamics after sTBI, and might be used in combination with biochemical biomarkers for better assessment. The decision to perform DC should include a re-assesment of ICP evolution, CT scan images and concentration of the biochemical biomarkers. Furthermore, when determining whether DC treatment should be used, surgeon should also consider the risks of the following cranioplasty.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2016. 134 p.
Umeå University medical dissertations, ISSN 0346-6612 ; 1836
Severe traumatic brain injury, ICP targeted therapy, ICP, decompressive craniectomy, S100B, NSE, cranioplasty
National Category
Other Medical Sciences Neurology
Research subject
urn:nbn:se:umu:diva-124069 (URN)978-91-7601-442-4 (ISBN)
Public defence
2016-09-02, Sal E04, byggnad 6A, Norrlands Universitetssjukhus, Umeå, 09:00 (Swedish)
Available from: 2016-08-18 Created: 2016-07-11 Last updated: 2016-10-14Bibliographically approved

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Olivecrona, ZandraBobinski, LukasKoskinen, Lars-Owe D.
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