Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia, USA.
World Neurosurg. 2014 Jan;81(1):151-8. doi: 10.1016/j.wneu.2013.01.015. Epub 2013 Jan 8.
Severe traumatic brain injury (TBI) is a dynamic neuropathologic process in which a substantial proportion of patients die within the first 48-hours. The assessment of injury severity and prognosis are of primary concern in the initial management of severe TBI. Supplemental testing that aids in the stratification of patients at high risk for deterioration may significantly improve posttraumatic management in the acute setting.
This retrospective study assessed the utility of both single-marker and multimarker models as predictive indicators of acute clinical status after severe TBI. Forty-four patients who sustained severe TBI (admission Glasgow Coma Scale [GCS] score ≤ 8) were divided into two cohorts according to a dichotomized clinical outcome at 72 hours after admission: Poor status (death or GCS score ≤ 8) and improved status (GCS score improved to >8). Threshold values for clinical status prediction were calculated for serum S-100B, matrix metalloproteinase-9, and plasma D-dimer, upon admission and at 24 hours after TBI by the use of receiver operating characteristic analysis. Performance characteristics of these single-marker predictors were compared with those derived from a multimarker logistic regression analysis.
Biomarkers with the greatest predictive value for poor status at 72 hours included serum S-100B on admission, as well as plasma D-dimer and serum S-100B at 24 hours, for which, associations were strongly significant. Multimarker analysis indicated no substantial improvement in prediction accuracy over the best single predictors during this time frame.
In conjunction with other clinical, physical, and radiologic evidence, blood-derived biochemical markers may serve to enhance prediction of early clinical trends after severe TBI.
严重创伤性脑损伤（TBI）是一种动态的神经病理学过程，其中相当一部分患者在伤后 48 小时内死亡。严重 TBI 初始管理的首要关注点是损伤严重程度和预后评估。辅助评估有助于对病情恶化风险较高的患者进行分层，这可能会显著改善创伤后急性期的管理。
本回顾性研究评估了单一标志物和多标志物模型作为严重 TBI 后急性临床状态预测指标的效用。根据入院后 72 小时的临床结局将 44 例严重 TBI 患者（入院格拉斯哥昏迷量表[GCS]评分≤8）分为两组：不良结局（死亡或 GCS 评分≤8）和改善结局（GCS 评分改善至＞8）。通过使用接受者操作特征分析，在入院时和 TBI 后 24 小时计算血清 S-100B、基质金属蛋白酶-9 和血浆 D-二聚体对临床状态预测的临界值。将这些单标志物预测因子的性能特征与来自多标志物逻辑回归分析的性能特征进行比较。
对 72 小时不良结局有最大预测价值的生物标志物包括入院时的血清 S-100B，以及 TBI 后 24 小时的血浆 D-二聚体和血清 S-100B，两者相关性显著。多标志物分析表明，在此时间范围内，与最佳单标志物相比，预测准确性没有实质性提高。
与其他临床、物理和影像学证据相结合，血液衍生的生化标志物可能有助于预测严重 TBI 后早期的临床趋势。
