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TraumaTic brain injury
Serum levels of gFaP and S100b predict outcomes in Tbi
investigators from the netherlands
have validated the predictive worth of
two biochemical markers for traumatic
brain injury (tBi). we showed that
glial fibrillary acid protein (GFaP) and
s100B levels in serum are adjuncts to the
assessment of brain damage following tBi
and, when combined with clinical variables,
may enhance our ability to provide accurate
prognoses for patients, says the studys
lead researcher Pieter vos, of the radboud
university nijmegen medical Centre.
in patients with tBi, treatment
decisions may be guided by neurological
prognoses. Current prognostic models
for tBi, which include various patient
characteristics and brain damage indices,
do not exhibit sufficiently high sensitivity
or specificity to accurately predict
outcomes in individual patients. it is
broadly felt among experts in the field that
the need exists to enlarge knowledge on
biochemical markers of injury, says vos.
in a previous study, vos and his
colleagues showed that serum levels of
nature reviews | neurology
GFaP (1.5 g/l) and s100B (1.13 g/l)
in patients with severe tBi could predict
death and unfavorable outcomes with
good sensitivity but poor specificity. the
new investigation aimed to validate
the prognostic capabilities of these serum
biomarkers in people with either moderate
(Glasgow Coma scale [GCs] 912) or
severe (GCs 38) tBi.
the researchers recorded various
patient characteristics and collected
serum samples on hospital admission.
GFaP and s100B levels were subsequently
measured, and patient outcomes were then
determined at 6 months after injury.
among the 79 patients who met the
studys inclusion criteria, those who died
within the follow-up period exhibited
33.4-fold and 2.1-fold higher median levels
of serum GFaP and s100B, respectively,
than those who were still alive at 6 months.
median serum levels of GFaP and
s100B were also increased (19.8-fold
and 2.1-fold, respectively) in patients
exhibiting unfavorable outcomes (Glasgow
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outcome scale extended [Gose] score
14) compared with individuals showing
favorable outcomes (Gose score 28).
logistical regression analysis showed that
models including the serum biomarkers
(at cut-off values determined in the
previous study), mass lesion and pupillary
reaction most accurately predicted
patient outcomes.
vos and his colleagues hypothesize
that in the case of tBi, cut-off values for
GFaP and s100B can be determined that
are associated with a small false-positive
rate of death or unfavorable outcomes.
to achieve this, says vos, we would
need to conduct a larger, multicenter
study, involving hundreds rather than
tens of patients with this serious and
heterogeneous disorder.
Darran Yates
Original article Vos, P. E. et al. GFAP and S100B are
biomarkers of traumatic brain injury: an observational
cohort study. Neurology 75, 17861793 (2010)
volume 7 | FeBruarY 2011 | 63