@article{MTMT:35198213, title = {Predicting recovery in patients with mild traumatic brain injury and a normal CT using serum biomarkers and diffusion tensor imaging (CENTER-TBI): an observational cohort study}, url = {https://m2.mtmt.hu/api/publication/35198213}, author = {Richter, S and Winzeck, S and Correia, MM and Czeiter, Endre and Whitehouse, D and Kornaropoulos, EN and Williams, GB and Verheyden, J and Das, T and Tenovuo, O and Posti, JP and Vik, A and Moen, KG and Håberg, AK and Wang, K and Büki, András and Maas, A and Steyerberg, E and Menon, DK and Newcombe, VFJ}, doi = {10.1016/j.eclinm.2024.102751}, journal-iso = {ECLINICALMEDICINE}, journal = {ECLINICALMEDICINE}, unique-id = {35198213}, issn = {2589-5370}, year = {2024}, eissn = {2589-5370}, orcid-numbers = {Czeiter, Endre/0000-0002-9578-6944} } @article{MTMT:34853080, title = {Acute neuroendocrine changes after traumatic brain injury}, url = {https://m2.mtmt.hu/api/publication/34853080}, author = {Magyar-Sümegi, Zsófia Dina and Stankovics, Levente and Lendvai-Emmert, Dominika and Czigler, András and Hegedüs, Emőke and Csendes, Márk Lajos and Tóth, Luca and Ungvári, Zoltán István and Büki, András and Tóth, Péter József}, doi = {10.1016/j.bas.2024.102830}, journal-iso = {BRAIN SPINE}, journal = {BRAIN AND SPINE}, volume = {4}, unique-id = {34853080}, issn = {2772-5294}, year = {2024}, eissn = {2772-5294}, orcid-numbers = {Ungvári, Zoltán István/0000-0002-6035-6039} } @{MTMT:34823718, title = {Súlyos koponyasérült betegek műtéti indikációja és kezelése}, url = {https://m2.mtmt.hu/api/publication/34823718}, author = {Büki, András and Kopniczky, Zsolt}, booktitle = {Súlyos baleseti agysérültek ellátása}, unique-id = {34823718}, year = {2024}, pages = {145-150} } @{MTMT:34823378, title = {A koponya- és agysérülés definíciója}, url = {https://m2.mtmt.hu/api/publication/34823378}, author = {Büki, András}, booktitle = {Súlyos baleseti agysérültek ellátása}, unique-id = {34823378}, year = {2024}, pages = {29-32} } @article{MTMT:34477399, title = {Screening Performance of S100B, GFAP and UCH-L1 For Intracranial Injury Within 6 hours of Injury and beyond}, url = {https://m2.mtmt.hu/api/publication/34477399}, author = {Trivedi, Dhanisha and Forssten, Maximilian Peter and Cao, Yang and Mohammad Ismail, Ahmad and Czeiter, Endre and Amrein, Krisztina and Kobeissy, Firas and Wang, Kevin K W and DeSoucy, Erik and Büki, András and Mohseni, Shahin}, doi = {10.1089/neu.2023.0322}, journal-iso = {J NEUROTRAUM}, journal = {JOURNAL OF NEUROTRAUMA}, volume = {41}, unique-id = {34477399}, issn = {0897-7151}, abstract = {The Scandinavian NeuroTrauma Committee (SNC) guidelines recommend S100B as a screening tool for early detection of Traumatic brain injury (TBI) in patients presenting with an initial Glasgow coma scale (GCS) of 14-15. The objective of the current study was to compare S100B's diagnostic performance within the recommended 6-hour window after injury, compared to GFAP and UCH-L1. The secondary outcome of interest was the ability of these biomarkers in detecting traumatic intracranial pathology beyond the 6-hour mark.The Center-TBI core database (2014-2017) was queried for data pertaining to all TBI patients with an initial GCS of 14-15 who had a blood sample taken within 6 hours of injury in which the levels of S100B, GFAP, and UCH-L1 were measured. As a subgroup analysis, data involving patients with blood samples taken within 6-9 hours, and 9-12 hours were analyzed separately for diagnostic ability. The diagnostic ability of these biomarkers for detecting any intracranial injury was evaluated based on the area under the receiver operating characteristic curve (AUC). Each biomarker's sensitivity, specificity, and accuracy were also reported at the cutoff that maximized Youden's index.A total of 531 TBI patients with GCS 14-15 on admission had a blood sample taken within 6 hours, of whom 24.9% (N = 132) had radiologically confirmed intracranial injury. The AUCs of GFAP (0.86, 95% confidence interval (CI): 0.82-0.90) and UCH-L1 (0.81, 95% CI: 0.76-0.85) were statistically significantly higher than that of S100B (0.74, 95% CI: 0.69-0.79) during this time. There was no statistically significant difference in the predictive ability of S100B when sampled within 6 hours, 6-9 hours, and 9-12 hours of injury, as the p-values were >0.05 when comparing the AUCs. Overlapping AUC 95% CI suggests no benefit of a combined GFAP and UCH-L1 screening tool over GFAP during the time periods studied [ 0.87 (0.83-0.90) vs 0.86 (0.82-0.90) when sampled within 6 hours of injury, 0.83 (0.78-0.88) vs 0.83 (0.78-0.89) within 6-to-9 hours and 0.81 (0.73-0.88) vs 0.79 (0.72-0.87) within 9-12 hours].Targeted analysis of the CENTER-TBI core database, with focus on the patient category for which biomarker testing is recommended by the SNC guidelines, revealed that GFAP and UCH-L1 perform superior to S100B in predicting CT-positive intracranial lesions within 6 hours of injury. GFAP continued to exhibit superior predictive ability to S100B during the time periods studied. S100B displayed relatively unaltered screening performance beyond the diagnostic timeline provided by SNC guidelines. These findings suggest the need for a re-evaluation of the current SNC TBI guidelines.}, keywords = {Biomarkers; traumatic brain injury; Head trauma; adult brain injury}, year = {2024}, eissn = {1557-9042}, pages = {349-358}, orcid-numbers = {Czeiter, Endre/0000-0002-9578-6944} } @article{MTMT:34474356, title = {Blood biomarkers for traumatic brain injury: A narrative review of current evidence}, url = {https://m2.mtmt.hu/api/publication/34474356}, author = {Hossain, I. and Marklund, N. and Czeiter, Endre and Hutchinson, P. and Büki, András}, doi = {10.1016/j.bas.2023.102735}, journal-iso = {BRAIN SPINE}, journal = {BRAIN AND SPINE}, volume = {4}, unique-id = {34474356}, issn = {2772-5294}, year = {2024}, eissn = {2772-5294}, orcid-numbers = {Czeiter, Endre/0000-0002-9578-6944} } @article{MTMT:35141163, title = {Relationship between the shape of intracranial pressure pulse waveform and computed tomography characteristics in patients after traumatic brain injury}, url = {https://m2.mtmt.hu/api/publication/35141163}, author = {Kazimierska, Agnieszka and Uryga, Agnieszka and Mataczynski, Cyprian and Czosnyka, Marek and Lang, Erhard W. and Kasprowicz, Magdalena}, doi = {10.1186/s13054-023-04731-z}, journal-iso = {CRIT CARE}, journal = {CRITICAL CARE}, volume = {27}, unique-id = {35141163}, issn = {1364-8535}, abstract = {Background Midline shift and mass lesions may occur with traumatic brain injury (TBI) and are associated with higher mortality and morbidity. The shape of intracranial pressure (ICP) pulse waveform reflects the state of cerebrospinal pressure-volume compensation which may be disturbed by brain injury. We aimed to investigate the link between ICP pulse shape and pathological computed tomography (CT) features.Methods ICP recordings and CT scans from 130 TBI patients from the CENTER-TBI high-resolution sub-study were analyzed retrospectively. Midline shift, lesion volume, Marshall and Rotterdam scores were assessed in the first CT scan after admission and compared with indices derived from the first 24 h of ICP recording: mean ICP, pulse amplitude of ICP (AmpICP) and pulse shape index (PSI). A neural network model was applied to automatically group ICP pulses into four classes ranging from 1 (normal) to 4 (pathological), with PSI calculated as the weighted sum of class numbers. The relationship between each metric and CT measures was assessed using Mann-Whitney U test (groups with midline shift > 5 mm or lesions > 25 cm(3) present/absent) and the Spearman correlation coefficient. Performance of ICP-derived metrics in identifying patients with pathological CT findings was assessed using the area under the receiver operating characteristic curve (AUC).Results PSI was significantly higher in patients with mass lesions (with lesions: 2.4 [1.9-3.1] vs. 1.8 [1.1-2.3] in those without; p << 0.001) and those with midline shift (2.5 [1.9-3.4] vs. 1.8 [1.2-2.4]; p < 0.001), whereas mean ICP and AmpICP were comparable. PSI was significantly correlated with the extent of midline shift, total lesion volume and the Marshall and Rotterdam scores. PSI showed AUCs > 0.7 in classification of patients as presenting pathological CT features compared to AUCs <= 0.6 for mean ICP and AmpICP.Conclusions ICP pulse shape reflects the reduction in cerebrospinal compensatory reserve related to space-occupying lesions despite comparable mean ICP and AmpICP levels. Future validation of PSI is necessary to explore its association with volume imbalance in the intracranial space and a potential complementary role to the existing monitoring strategies.}, keywords = {CLASSIFICATION; PREDICTION; MANAGEMENT; traumatic brain injury; computed tomography; Intracranial Pressure; Decompressive craniectomy; elastance; Morphological analysis; pulse waveform; VOLUME-PRESSURE}, year = {2023}, eissn = {1466-609X}, orcid-numbers = {Uryga, Agnieszka/0000-0001-8183-7643; Czeiter, Endre/0000-0002-9578-6944} } @article{MTMT:34392087, title = {Mild traumatic brain injury-induced persistent blood–brain barrier disruption is prevented by cyclosporine A treatment in hypertension}, url = {https://m2.mtmt.hu/api/publication/34392087}, author = {Lendvai-Emmert, Dominika and Magyar-Sümegi, Zsófia Dina and Hegedüs, Emőke and Szarka, Nikolett and Fazekas, Bálint and Amrein, Krisztina and Czeiter, Endre and Büki, András and Ungvári, Zoltán István and Tóth, Péter József}, doi = {10.3389/fneur.2023.1252796}, journal-iso = {FRONT NEUR}, journal = {FRONTIERS IN NEUROLOGY}, volume = {14}, unique-id = {34392087}, issn = {1664-2295}, year = {2023}, eissn = {1664-2295}, orcid-numbers = {Fazekas, Bálint/0000-0002-8445-4100; Czeiter, Endre/0000-0002-9578-6944; Ungvári, Zoltán István/0000-0002-6035-6039} } @article{MTMT:34050791, title = {Prognostic Value of Serum Biomarkers in Patients With Moderate-Severe Traumatic Brain Injury, Differentiated by Marshall Computer Tomography Classification}, url = {https://m2.mtmt.hu/api/publication/34050791}, author = {Richter, Sophie and Czeiter, Endre and Amrein, Krisztina and Mikolic, Ana and Verheyden, Jan and Wang, Kevin K and Maas, Andrew and Steyerberg, Ewout and Büki, András and Menon, David and Newcombe, Virginia}, doi = {10.1089/neu.2023.0029}, journal-iso = {J NEUROTRAUM}, journal = {JOURNAL OF NEUROTRAUMA}, volume = {40}, unique-id = {34050791}, issn = {0897-7151}, abstract = {Prognostication is challenging in traumatic brain injury (TBI) patients in whom the CT fails to fully explain a low level of consciousness. Serum biomarkers reflect the extent of structural damage in a different way than CT does, but it is unclear if biomarkers provide additional prognostic value across the range of CT abnormalities. This study aimed to determine the added predictive value of biomarkers, differentiated by imaging severity. This prognostic study used data from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study (2014-2017). The analysis included patients aged ≥16 years with a moderate-severe TBI (Glasgow Coma Scale, GCS < 13) who had an acute CT and serum biomarkers obtained ≤24h of injury. Out of six protein biomarkers (GFAP, NFL, NSE, S100B, Tau, UCH-L1) the most prognostic panel was selected using lasso regression. The performance of established prognostic models (CRASH and IMPACT) was assessed before and after the addition of the biomarker panel, and compared between patients with different CT Marshall scores (Marshall score <3 versus Marshall score ≥3). Outcome was assessed at 6 months post-injury using the extended Glasgow Outcome Scale (GOSE), and dichotomized into favorable and unfavourable (GOSE <5). We included 872 patients with moderate-severe TBI. The mean age was 47 years (range 16 - 95), 647 (74%) were male and 438 (50%) had a Marshall CT score <3. The serum biomarkers GFAP, NFL, S100B and UCH-L1 provided complementary prognostic information, NSE and Tau showed no added value. The addition of the biomarker panel to established prognostic models increased the area under the curve (AUC) by 0.08 and 0.03, and the explained variation in outcome by 13-14% and 7-8%, for patients with a Marshall score of <3 and ≥3, respectively. The incremental AUC of biomarkers for individual models was significantly greater when the Marshall score was <3 compared to ≥3 (p < 0.001). Serum biomarkers improve outcome prediction after moderate-severe TBI across the range of imaging severities and especially in patients with a Marshall score <3.}, keywords = {Biomarkers; prospective study; traumatic brain injury; adult brain injury; CT scanning}, year = {2023}, eissn = {1557-9042}, pages = {2297-2310}, orcid-numbers = {Czeiter, Endre/0000-0002-9578-6944} } @article{MTMT:34021464, title = {The lower limit of reactivity as a potential individualised cerebral perfusion pressure target in traumatic brain injury : a CENTER-TBI high-resolution sub-study analysis}, url = {https://m2.mtmt.hu/api/publication/34021464}, author = {Beqiri, Erta and Zeiler, Frederick A and Ercole, Ari and Placek, Michal M and Tas, Jeanette and Donnelly, Joseph and Aries, Marcel J H and Hutchinson, Peter J and Menon, David and Stocchetti, Nino and Czosnyka, Marek and Smielewski, Peter}, doi = {10.1186/s13054-023-04485-8}, journal-iso = {CRIT CARE}, journal = {CRITICAL CARE}, volume = {27}, unique-id = {34021464}, issn = {1364-8535}, abstract = {A previous retrospective single-centre study suggested that the percentage of time spent with cerebral perfusion pressure (CPP) below the individual lower limit of reactivity (LLR) is associated with mortality in traumatic brain injury (TBI) patients. We aim to validate this in a large multicentre cohort.Recordings from 171 TBI patients from the high-resolution cohort of the CENTER-TBI study were processed with ICM+ software. We derived LLR as a time trend of CPP at a level for which the pressure reactivity index (PRx) indicates impaired cerebrovascular reactivity with low CPP. The relationship with mortality was assessed with Mann-U test (first 7-day period), Kruskal-Wallis (daily analysis for 7 days), univariate and multivariate logistic regression models. AUCs (CI 95%) were calculated and compared using DeLong's test.Average LLR over the first 7 days was above 60 mmHg in 48% of patients. %time with CPP < LLR could predict mortality (AUC 0.73, p = < 0.001). This association becomes significant starting from the third day post injury. The relationship was maintained when correcting for IMPACT covariates or for high ICP.Using a multicentre cohort, we confirmed that CPP below LLR was associated with mortality during the first seven days post injury.}, keywords = {traumatic brain injury; Cerebral autoregulation; Lower limit of reactivity; Individualised cerebral perfusion pressure}, year = {2023}, eissn = {1466-609X}, orcid-numbers = {Czeiter, Endre/0000-0002-9578-6944} }