Quality of life after severe head injury correlates to S100B serum level

Objective

S100B protein is a new possible indicator of brain damage after severe head injury. Peak values of S100B serum concentrations during the first days after trauma were significantly correlated to survival after severe head injury. In outcome assessment there is an increasing focus on measures of health outcome incorporating the patients own perspective. Therefore the aim of our study was to investigate the correlation of early S100B serum level to the quality of life and outcome after severe head injury.

Methods

We included 51 patients with severe head injury (GCS <9), who had been admitted between 1 and 6 hours after injury, in a prospective study. Blood samples were taken on admission (mean 2.5 hours). The serum was analyzed for S100B concentrations by using a RIA (Byk-Sangtec). S100B serum values above 0.5 μg/l were defined to be elevated. The outcome was assessed at follow-up (mean 11.9 months after trauma, follow-up rate 100%) using the Glasgow Outcome Scale (GOS 1–3 = unfavourable, GOS 4–5 = favourable) and a questionnaire to assess the quality of life (QOL) according to Blau consisting of 10 items (job, leisure, eating, sleeping, friends, money, family, partnership, health and self assessment). A quality of life index was calculated.

Results

Patients with unfavourable outcome had significantly higher serum concentrations of S100B compared to the patients with favourable outcome (4.9 μg/l versus 1.6 μg/l, P < 0.0008). In the evaluation of all patients the QOL concerning all items is significantly lower in the group with S-100B serum concentrations above 2 μg/l on admission (19.6 versus 51.2 points, mean, P < 0.0007). The overall rating of QOL was in the same range in these groups (15.2 versus 50.4 points, mean, P < 0.0002). Concerning the survivors the quality of life index and the overall quality of life is significantly higher in the group of patients with S100B concentrations ≤ 0.5 μg/l on admission (71.4 versus 55.4 points, mean, P < 0.05)

Conclusion

Thus S100B seems not only to be able to predict survival but also to assess the extent of primary brain damage after trauma.