Correlation of Computed Tomography Findings and Serum Brain Damage Markers Following Severe Head Injury
The objective of our study was to investigate the association between the initial levels of serum S-100B protein and neuron specific enolase and the severitiy of radiologically visible brain damage and outcome after severe head injury.
Admission computed tomography (CT) scans of forty-four patients with severe head injury were analysed. Initial levels of S-100B protein and neuron specific enolase were compared between the different outcome groups at 6 month, the different categories of the Marshall classification, the presence of traumatic subarachnoid haemorrhage, the type of haematoma and the volume of contusion.
Serum S-100B was significantly higher in patients with unfavourable outcome (1.1 μg/1 versus 0.3 μg/1, p<0.005, Mann-Whitney U test). In diffuse injury, unfavourable outcome significantly increased with higher Marshall grades (p<0.05). There was a significant correlation between the four grades of diffuse injury and initial serum S-100B protein (r=0.48, p<0.001). Patients with focal mass lesions and a favourable outcome after 6 month had significantly lower S-100B values than those who had an unfavourable outcome (0.51 μg/l versus 1.3 μg/1, p<0.05). A significant correlation was demonstrated between the volume of contusion visible on CT scans and serum S-100B (r=0.58, p<0.001).
In our study, initial serum S-100B protein was a powerful predictor of outcome even within the same category of radiologically visible brain damage. Serum S-100B protein may provide independent information about the severity of primary brain damage after head injury.
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