Elecsys® S100

Monitoring the cerebral status of patients with severe TBI

Elecsys S100

Monitoring the cerebral status of patients with severe TBI

Patients with a severe TBI are at high risk of post-traumatic events, such as intracranial bleeding or brain edema, which lead to a rise in intracranial pressure and secondary brain damage. In such cases, rapid intervention is essential in order to relieve the intracranial pressure through medication and/or surgery (craniotomy).

S100 serum measurement is proven in monitoring the cerebral status of patients with severe TBI. As the majority of individuals do not have clinically significant intracerebral lesions on CT scan, a negative S100 value is a valuable tool for ruling out pathological findings and preventing unnecessary CT Scanning after minor head injury.

Aid in the management of patients suffering from malignant melanoma: Simple test adds: "In patients suffering from malignant melanoma, especially stage II, III, and IV, elevated S100 serum levels may indicate disease progression. Serial measurements can be useful for follow-up and monitoring therapy success in these patients."7-13

In a prospective multicenter study of 1,309 patients with minor head injury, an S100B cutoff of 0.10 μg/L (the 95th percentile of healthy volunteers) identified those patients with trauma-relevant CT findings with a sensitivity of 99% and a negative predictive value of 99.68%.3

A meta-analysis of 12 studies of adults with minor head injury reported a pooled sensitivity for S100B for the prediction of CT findings of 97% (95% CI, 91–99%) and pooled specificity of 40% (95% CI, 30–51%) This equated to a negative predictive value of >99% (95% CI, 98–100%) at an average prevalence for intracranial findings after minor head injury of 8%.8 Omitting CT in adults with minor head injury and an S100B concentration of <0.10 μg/L would reduce the number of CTs by approximately one-third.8

International guidelines advise that adult patients with mild head injury and no risk factors who have a serum S100B level <0.10 μg/L measured within 6 hours of injury may be discharged without the need for CT.

S100B CCT+ CCT-  
>0.10 µg/L
92 855 Positive predictive value, 10% (95% CI, 7-13%)
≤ 0.10 µg/L
1 361 Negative predictive value 99.68% (95% CI, 99-100%)
Total 93 1,216 1,309
  Sensitivity 99% (95% CI, 96-100%) Specifity, 30% (95% CI, 29-31%)  

Contingency table for serum S100B according to cranial CT (CCT) findings in 1,309 patients with minor head injury.3 CCT-, patients without any sign of trauma-relevant intracerebral lesions on CT; CCT+, patients with at least one trauma-relevant CT finding.

The specifity of only 30% at this cutoff value indicates that elevated S100B levels may also indicate head injuries that are not reflected by the initial CCT scan

Benefits

  • S100B testing can help determine which low-risk patients with minor head injury do not need a CT scan
  • S100 levels predict short-, medium-, and long-term patient outcome
  • Monitoring progression of severe TBI with S100 assays
  • S100B levels correlate with the severity of brain damage
  • S100 levels may indicate secondary neurological deterioration in patients with severe TBI
  • S100 it's an helpful tool for management of malignant melanoma patients
Elecsys S100

Elecsys® S100

  • Assay Time

    18 min

  • Sample Material

    Human Serum

  • Sample Volume

    20 µL

  • Detection Limit

    0.4 pg/mL

  • Measuring Range

    15‑30000 pg/mL

  1. Faul, M., Xu, L., Wald, M. M., & Coronado, V. G. (2010). Traumatic brain injury in the United States: emergency department visits, hospitalizations, and deaths 2002-2006. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. http://www.cdc.gov/traumaticbraininjury/pdf/blue_book.pdf
  2. Zongo, D., Ribéreau-Gayon, R., Masson, F., Laborey, M., Contrand, B., Salmi, L. R. et al. (2012). S100-B protein as a screening tool for the early assessment of minor head injury. Ann Emerg Med, 59(3), 209-218.
  3. Biberthaler, P., Linsenmeier, U., Pfeifer, K. J., Kroetz, M., Mussack, T., Kanz, K. G. et al. (2006). Serum S-100B concentration provides additional information fot the indication of computed tomography in patients after minor head injury: a prospective multicenter study. Shock, 25(5), 446-453
  4. Bloomfield, S. M., McKinney, J., Smith, L. & Brisman, J. (2007). Reliability of S100B in predicting severity of central nervous system injury. Neurocrit Care, 6(2), 121-138.
  5. Pelinka, L. E., Toegel, E., Mauritz, W. & Redl, H. (2003). Serum S 100 B: a marker of brain damage in traumatic brain injury with and without multiple trauma. Shock, 19(3), 195-200.
  6. Murillo-Cabezas, F., Muñoz-Sánchez, M. A., Rincón-Ferrari, M. D., Martín-Rodríguez, J. F., maya-Villar, R., García-Gómez, S. et al. (2010). The prognostic value of the temporal course of S100beta protein in post-acute severe brain injury: A prospective and observational study. Brain Inj, 24(4), 609-619.
  7. Mercier, E., Boutin, A., Lauzier, F., Fergusson, D. A., Simard, J. F., Zarychanski, R. et al. (2013). Predictive value of S-100beta protein for prognosis in patients with moderate and severe traumatic brain injury: systematic review and meta-analysis. BMJ, 346f1757 19

References to add??: 

Guo HB, Stofffel-Wagner B, Bierwirth T, et al. Clinical significance of serum S100 in metastatic malignant melanoma. Eur J Cancer 1995;31A:924-928.

8. Mohammed MQ, Abraha HD, Sherwood RA, et al. Serum S100β protein as a marker of disease activity in patients with malignant melanoma. Med Oncol 2001;18:109-120.

9. Krähn G, Kaskel P, Sander S, et al. S100β is a more reliable tumor marker in peripheral blood for patients with newly occurred melanoma metastases compared with MIA, albumin and lactate-dehydrogenase. Cancer Research 2001;21:1311-1316.

10. von Schoultz E, Hansson LO, Djureen E, et al. Prognostic value of serum analysis S-100β protein in malignant melanoma. Melanoma Research 1996;6:133-137.

11. Abraha HD, Fuller LC, Vivier AW, et al. Serum S-100 protein: a potentially useful prognostic marker in cutaneous melanoma. Br J Dermatol 1997;137:381-385.

12. Garbe C, Leiter U, Ellwanger U, et al. Diagnostic Value and Prognostic Significance of Protein S-100 β, Melanoma-Inhibitory Activity, and Tyrosinase/MART-1 Reverse Transcription-Polymerase Chain Reaction in the Follow-Up of High-Risk