The Value Of Blood S100B Protein In Judging The Outcome After Acute Traumatic Brain Injury And Meta-analysis

Objective:To investigate the changes of plasm S100B protein and their values inoutcome after acute traumatic brain injury.And to assess that whether blood S100B protein could be a new effective marker ofpredicting outcome after traumatic brain injury．Methods:We collected the blood of20heath person and the blood of44TBI patientson admission, on the first day after injury,On the third day after injury and on the seventhday after injury.Then dynamically detected the levels of blood S100B protein by ELASAand assessed the outcome of six mouths after injury by use of GOS grading.They weredivided into unfavorable prognosis group (n=21)and favorable prognosis group(n=23)according to GOS grading.The numerical variable were expressed by x±s.The data werecompared by independent samples t-test or nonparametric tests according to thecorresponding style.Receiver operating characteristic (ROC) curve was used to evaluatethe predictive value of GCS grading and blood S100B on admission.We searched studieswith quantitative data using the items “S-100or S-100B, cerebral trauma or traumaticbrain injury or head injury or cerebral injury,prognosis or outcome” through searching8databases on line(Oct．1999-Oct．2011),which were written in English or Chinese．In thispaper,we used the method of meta-analysis and the softwares of Revman4．2andStata11.0，to analysis all the studies which comparing the situation of the blood S100Bprotein in unfavorable prognosis group and favorable prognosis group after TBI inaccordance with our inclusion criteria.Results:1.Plasma S100B protein of favorable outcome group after TBI reaches to thepeak at the first24hour,then decline to normal in the next3-7days.Plasma S100B protein of unfavorable outcome group declined a lit through active treat,but would rise againfollowing the development of the disease.2.Plasma S100B protein of unfavorable outcome group was obviously higher than thefavorable outcome group on four different time,the difference has statistical significance(P<0.05).3.The Spearman coefficient of rank correlation between Plasma S100B protein andGOS grading was-0.669（P=0.000） on admission.Comparing with the Spearmancoefficient of rank correlation between GCS grading and GOS grading onadmission(r=0.354,P=0.019),It was provided with stronger correlation.4.The content of Plasma S100B on admission had more values in judging theprognosis than GCS grading （AUC0.867vs0.672),the difference had statisticalsignificance (P=0.024<0.05).5.The value in judging the prognosis when Plasma S100B was detected on the seventhday after injury was the highest（AUC=0.946).The sensitivity was95.24%,and thespecificity was86.96%.6.We identified2Chinese and6english eligible studies with227cases of unfavorableoutcome patients and399favorable outcome patients.There was no publication bias in mystudy, The funnel plot was symmetric and the fail-safe number was467.01. It had not showheterogeneity(I2=0％，P=0.56),So that a fixed effect model was applied.Our resultsshowed:Compared with the group of blood S100B below the critical value, Theprobability of the group of blood S100B above the critical value resulted in unfavorableprognosis increased obviously,the difference had statistical significance(Combined OR14.43,95％CI[9.00,23.13]).SEN was0．67,SPE was O.81，+LR was4.13，-LR was0．34，SROC area under the curve was0．85.Conclusion: The blood S100B protein was closely related to the prognosis ofpatients with TBI. Its detection possessed very high value of predicting prognostic.Themeta-analysis results showed:Compared with the group of blood S100B below the criticalvalue, The probability of the group of blood S100B above the critical value resulted in unfavorable prognosis increased obviously.The strength of evidence was mediumstrength,it could be recommended as clinical application evidence, but we still needinclude more high quality original research to support results.