• Axel Petzold, Alison J E Green, Geoff Keir, Sandra Fairley, N Kitchen, Martin Smith, and E J Thompson.
• Department of Neuroimmunology, Institute of Neurology, Queen Square, London WC1N 3BG, United Kingdom. a.petzold@ion.ucl.ac.uk
• Crit. Care Med. 2002 Dec 1;30(12):2705-10.

ObjectiveTo investigate whether serum S100B is suitable as a sensitive biomarker for early prediction of increased intracranial pressure and mortality rates after brain injury.DesignA prospective, longitudinal study.SettingNeurosurgical intensive care unit.PatientsTwenty-one patients with acute brain injury and 13 healthy controls.InterventionsNone.Measurements And Main ResultsWe assessed Glasgow Coma Scale score and pupil reaction on admission and quantified serum S100B (in-house enzyme-linked immunosorbent assay) and intracranial pressure on admission and the subsequent 6 days. Serum S100B concentrations on admission and day 1 were significantly higher in patients with fatal outcome (p <.05, p<.01, respectively), with a sensitivity of 100% and a specificity of 75-83%. Patients with high serum S100B on admission had an eight-fold and on day 1 a 12-fold increased relative risk of a fatal outcome. Subsequent serum S100B values predicted the development of high intracranial pressure in patients with traumatic brain injury (p <.01). Patients with high intracranial pressure on day 5 had an 11-fold and on day 6 a nine-fold increased risk of fatal outcome.ConclusionsSerum S100B is a sensitive biomarker for early prediction of the development of high intracranial pressure and fatal outcome following acute brain injury. Monitoring S100B concentrations could contribute to early detection of patients at risk of secondary increases in intracranial pressure and subsequent mortality. This would allow earlier targeting of therapy in selected patients.

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