The role of clinical scoring systems and the serum level of S100B protein in predicting the outcome of acute toxic comatosed patients

Background : Toxic coma represents a neurological emergency needing prompt evaluation and intervention, particularly in the critical first hours. Objectives : To assess the prognostic value of S-100B protein levels, the Glasgow coma scale (GCS), the Reed score, and modified APACHE II system (MAS) in patients with acute toxic coma. Methods : A prospective cohort study was performed on 69 cases diagnosed with acute toxic coma and admitted to the Menoufia Poison and Dependence Control Center (MPDCC) over one year. S100B protein levels were measured and clinical scores were calculated for all cases. Results: S-100B protein levels were significantly elevated in toxic coma cases in comparison with controls (7.35±2.27 vs. 3.39±1.04). Strong correlations were found between S-100B levels and clinical scores, showing a negative correlation with GCS and a positive correlation with MAS. S-100B demonstrated high predictive value for mortality (AUC = 0.939, sensitivity 93%, specificity 76% at a cutoff of 7.439). Severe grades of GCS, Reed scale, and MAS were strongly associated with mortality. Conclusion : S-100B protein is an excellent prognostic marker for mortality in acute toxic coma patients. Severe grades of GCS, Reed scale, and MAS were strongly linked to poor outcomes.