S100 beta is a marker of brain insult caused by systemic inflammatory response syndrome

Introduction

Central nervous system (CNS) failure along with other systems is included in septic multiorgan failure; however, in our opinion, it is the less studied. Earlier, a S100β level rise was described for septic encephalopathy patients, but together with this sites of a local ischemia or a bleed were discovered according to computer tomography in a brain [1]. The purpose of the present study is to determine whether it is the functional or the organic CNS insult that defines septic encephalopathy and to study the dependence of septic encephalopathy on the severity of sepsis.

Methods

The prospective study involves 28 septic patients according to sepsis criteria and ACCP/SCCM classifications. The primary site localization of infection in our study excluded the CNS according to computer tomography. After the approval of the hospital ethics committee we investigated the patients without neurological disturbances. The patients were divided into two groups. The first group (n = 12) included the patients with various degrees of impairment of consciousness (<15 points of the Glasgow coma scale). The second group (n = 16) included patients without any disturbances of consciousness. There were no differences between groups in age, gender, severity of sepsis, the cortisone level, lactate, and arterial and jugular bulb blood saturation.

Results

The S100β level in group 1 was reliably higher than in group 2, and on average it surpassed the normal rate by 2.6 times (group 2 showed the S100β level as not exceeding the normal level of 0.15 units/ml). Venous blood saturation in the two groups reliably did not differ and was within the norm. However, the saturation of the jugularis blood in group 1 was equal to 57.64 ± 13.3, which is below the norm. Venous blood lactate exceeded in group 2, while group 1 showed a normal rate both in venous and jugular blood (lactate jugular = 1.76). The 28-day mortality was reliably higher in group 1. The S100β level correlated with mortality.

Conclusion

CNS failure under septic encephalopathy is of organic character and relates to CNS cell necrosis that is not of focal character. The results obtained have suggested that the S100β level may be considered a marker of unfavorable outcome in patients with severe sepsis.