Evaluation of the Possible Role of S100B, Troponin I and C- Reactive Protein Levels as Prognostic Markers in Cases of Traumatic Intra-Cerebral and Subarachnoid Hemorrhage

Abeer Sheta,Mohamed Megahed,Osama Mansour,Haidy Megahed

doi:10.21608/ajfm.2014.18678

Abeer Sheta, Mohamed Megahed + Show 2 more

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https://doi.org/10.21608/ajfm.2014.18678

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Abstract

Introduction; Traumatic head injury is a major cause of morbidity and mortality across the globe. Even in minor head injuries, long term neuropsychological deficits may occur. The assessment of certain biochemical markers in serum can help to predict outcomes. S100B is a protein biomarker that reflects CNS injury. Cardiac troponin I (cTnI) is a specific marker of myocardial injury. C-reactive protein (CRP) is an acute-phase protein that increases rapidly in response to infection, trauma, and other inflammatory conditions. The present study aimed to evaluate the possible role of S100B, troponin I and C- reactive protein levels as prognostic markers in cases of traumatic intra-cerebral and subarachnoid hemorrhage. Subjects and method; This study was conducted on 40 patients of both sexes; 20 patients of traumatic intracerebral hemorrhage (ICH) and 20 patients of traumatic subarachnoid hemorrhages (SAH) within 24 hours after traumatic hemorrhage. Glasgow Coma Scale (GCS) was evaluated on admission, within 24 of trauma, for all patients. Brain CT scan was also performed for all patients and Fisher grade was assessed for SAH patients. A daily electrocardiogram was performed. Serum samples were taken from all patients at day one and day three. All samples were analyzed for S100B, cardiac troponin I and C-reactive protein. Glasgow Outcome Scale (GOS) obtained at time of death or after three months Results; serum S100B, cTnI and CRP levels were negatively correlated with the severity of GCS and GOS among patients with ICH or SAH, except the level of cTnI level on third day among patients with ICH. Furthermore, patients with unfavorable outcome had significantly higher serum S100B, cTnI and CRP levels than favorable outcome. The highest correlation of all biomarkers, in both ICH and SAH, was noticed between S100B level on third day and GOS. Conclusion; S100bB levels on third day showed a highest correlation with GOS in patients with ICH or SAH.

Highlights

Traumatic head injury is a major cause of morbidity and mortality across the globe at all ages
This prospective study was conducted on 40 patients of both sexes; 20 patients of traumatic intracerebral hemorrhage (ICH) and 20 patients of traumatic subarachnoid hemorrhage (SAH) who were admitted to Critical Care Medicine department at the Alexandria Main University Hospital within 24 hours after traumatic hemorrhage
A significant correlation was found between the initial Glasgow Coma Scale (GCS) score and Glasgow Outcome Scale (GOS) ( r= 0.883, at p≤ 0.001)

Summary

Introduction

Traumatic head injury is a major cause of morbidity and mortality across the globe at all ages. Even in minor head injuries with a good outcome, long term neuropsychological deficits may occur (Teasdale et al, 1998). Accurate prediction of long term outcome and neurological assessment can help clinically, allow early rehabilitation and assess medico legal responsibility of health care providers. An accurate evaluation of the severity of CNS injury can help to predict outcomes and rationally help to decide when the application of aggressive therapeutic interventions would be appropriate (Bloomfield et al, 2007). Sheta et al, / Ain Shams J Forensic Med Clin Toxicol, July 2014 (23):102

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