Cerebrospinal fluid concentrations of S-100β protein, an acidic calcium-binding protein found in astrocytes and Schwann cells, increase after central nervous system damage. Serum S-100β protein, thus, has been expected to be a biochemical marker of brain cell damage. Several reports show a relation between severity of head injury and serum S-100β protein levels, although, there are still not significant advances in the study of S-100β regarding the prediction of the clinical outcome in brain diseases. The objective of the present study was to verify S-100βas a marker for the clinical outcome in patients with encephalopathy. Serum S-100β protein concentrations (pg/ml) were measured daily using ELISA until discharge from the intensive care unit (ICU) in 82 patients (54 men, 28 women; age 20-93 years [mean 61.0 ± 19.2]) with moderate or severe encephalopathy. There were 50 survivors and 32 non-survivors. S-100β levels were significantly lower in survivors (240.2 pg/ml) than in non-survivors (1,594.8 pg/ml) from day 1 until ICU discharge. The electroencephalogram (EEG) and computed tomography (CT) abnormalities were correlated with S-100β levels. The optimal cut-off value at 451.2 pg/ml calculated from ROC curve analysis showed the sensitivity of 80.2% and specificity of 78.1% for ICU mortality. Our results indicate that serum S-100β protein could be a useful biomarker to assess brain damage and predict prognosis in patients with encephalopathy.