The potential of human serum S100 Calcium-binding Protein B, Glial Fibrillary Acidic Protein, Neuron-Specific Enolase, and Serum Amyloid A as biomarkers for Traumatic Brain injury in moderate and severe cohort.

Abstract

Background: Traumatic brain injury (TBI) occurs due to a severe head injury caused by an external force during a vehicle accident, fall, domestic violence, or explosion. In sub-Saharan Africa, the prevalence of TBI is 150–170 per 100,000 individuals. It is estimated that by 2050, the prevalence of TBI in Africa will increase to 14.25±0.75 million. TBI is clinically evaluated and classified using the Glasgow Coma Score (GCS), with CT and MRI. However, GCS has many limitations. Therefore, the aim of this study was to investigate the role of serum GFAP, S100B, NSE and SAA as potential biomarkers for the detection and diagnosis of TBI. Methodology: The first phase of the experiment was the scan analysis (n=50) as recorded in the hybrid electronic medical registry, MediTech, at a large urban tertiary referral hospital in eThekwini, South Africa. The second phase utilized a multiplex immunoassay (ProcartaPlex, Thermo Fisher Scientific, 2024) to detect human serum GFAP, S100B, NSE and SAA in n=50 patients with moderate to severe TBI and n=25 control patients. Ethics approval was obtained from the Biomedical Research Ethics Committee (Ref. BREC/00002147/2020) of the University of KwaZulu-Natal. Statistical analysis was achieved using Statistical Package for the Social Sciences version 30.0.0.0 (SPSS; IBM Corporation 2025). Results: Serum GFAP and S100B concentrations were significantly elevated in patients with moderate and severe TBI compared with the control group (P < 0.001). No significant differences between the moderate and severe groups were detected for GFAP or S100B (P=0.2623, P>0.999). The serum concentrations of NSE and SAA proteins were also significantly upregulated in the moderate and severe TBI compared to the control group (p<0.0001) and (p= 0.0002), respectively. Conclusion: These findings suggest that elevated serum concentrations of GFAP, S100B, NSE and SAA are indicative of increasing severity of TBI. These findings suggest that combining GFAP, S100B, NSE, and SAA biomarkers with GCS and CT findings enhances the accuracy of TBI classification.