Blood biomarkers on admission in acute traumatic brain injury : Relations to severity, CT findings and care path in the CENTER-TBI study

Czeiter, Endre ✉ [Czeiter, Endre (Neurotrauma), szerző] Idegsebészeti Klinika (PTE / ÁOK); MTA-PTE Klinikai Idegtudományi Képalkotó Kutató... (PTE / KCS); Neurotrauma kutatócsoport (PTE / SZKK); Amrein, Krisztina* [Amrein, Krisztina (PhD Orvostudomány), szerző] Idegsebészeti Klinika (PTE / ÁOK); Neurotrauma kutatócsoport (PTE / SZKK); Gravesteijn, Benjamin Y*; Lecky, Fiona; Menon, David K; Mondello, Stefania; Newcombe, Virginia F J; Richter, Sophie; Steyerberg, Ewout W; Vyvere, Thijs Vande; Verheyden, Jan; Xu, Haiyan; Yang, Zhihui; Maas, Andrew I R**; Wang, Kevin K W**; Büki, András [Büki, András (Idegsebészet, ide...), szerző] Idegsebészeti Klinika (PTE / ÁOK); Neurotrauma kutatócsoport (PTE / SZKK); CENTER-TBI Participants and Investigators [Kollaborációs szervezet]

Angol nyelvű Sokszerzős vagy csoportos szerzőségű szakcikk (Folyóiratcikk) Tudományos
Megjelent: EBIOMEDICINE 2352-3964 2352-3964 56 Paper: 102785 , 11 p. 2020
  • SJR Scopus - Biochemistry, Genetics and Molecular Biology (miscellaneous): D1
  • (20765-3/2018/3(FEKUTSTRAT))
  • (2.3.3-15-2016-00032) Támogató: GINOP
  • (GINOP-2.3.2-15-2016-00048)
  • Hungarian Brain Research Program(2017-1.2.1-NKP-2017-00002)
  • Biomarkerek
Serum biomarkers may inform and improve care in traumatic brain injury (TBI). We aimed to correlate serum biomarkers with clinical severity, care path and imaging abnormalities in TBI, and explore their incremental value over clinical characteristics in predicting computed tomographic (CT) abnormalities.We analyzed six serum biomarkers (S100B, NSE, GFAP, UCH-L1, NFL and t-tau) obtained <24 h post-injury from 2867 patients with any severity of TBI in the Collaborative European NeuroTrauma Effectiveness Research (CENTER-TBI) Core Study, a prospective, multicenter, cohort study. Univariable and multivariable logistic regression analyses were performed. Discrimination was assessed by the area under the receiver operating characteristic curve (AUC) with 95% confidence intervals.All biomarkers scaled with clinical severity and care path (ER only, ward admission, or ICU), and with presence of CT abnormalities. GFAP achieved the highest discrimination for predicting CT abnormalities (AUC 0•89 [95%CI: 0•87-0•90]), with a 99% likelihood of better discriminating CT-positive patients than clinical characteristics used in contemporary decision rules. In patients with mild TBI, GFAP also showed incremental diagnostic value: discrimination increased from 0•84 [95%CI: 0•83-0•86] to 0•89 [95%CI: 0•87-0•90] when GFAP was included. Results were consistent across strata, and injury severity. Combinations of biomarkers did not improve discrimination compared to GFAP alone.Currently available biomarkers reflect injury severity, and serum GFAP, measured within 24 h after injury, outperforms clinical characteristics in predicting CT abnormalities. Our results support the further development of serum GFAP assays towards implementation in clinical practice, for which robust clinical assay platforms are required.CENTER-TBI study was supported by the European Union 7th Framework program (EC grant 602150).
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2022-12-08 06:36