Department of Neurosurgery, Medical School, University of Pécs, Rét u. 2, H-7623 Pécs, Hungary; Neurotrauma Research Group, Szentágothai Research Centre, University of Pécs, Ifjúság útja 20, H-7624 Pécs, Hungary; MTA-PTE Clinical Neuroscience MR Research Group, Rét u. 2, H-7623 Pécs, Hungary.
Department of Neurosurgery, Medical School, University of Pécs, Rét u. 2, H-7623 Pécs, Hungary; Neurotrauma Research Group, Szentágothai Research Centre, University of Pécs, Ifjúság útja 20, H-7624 Pécs, Hungary.
EBioMedicine. 2020 Jun;56:102785. doi: 10.1016/j.ebiom.2020.102785. Epub 2020 May 25.
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).
血清生物标志物可提供信息并改善创伤性脑损伤（TBI）的护理。我们旨在将血清生物标志物与 TBI 的临床严重程度、护理路径和影像学异常相关联，并探索其在预测 CT 异常方面对临床特征的增量价值。
我们分析了来自协作性欧洲神经创伤有效性研究（CENTER-TBI）核心研究的 2867 例任何严重程度 TBI 患者受伤后<24 小时内获得的 6 种血清生物标志物（S100B、NSE、GFAP、UCH-L1、NFL 和 t-tau）。进行了单变量和多变量逻辑回归分析。通过具有 95%置信区间的接收器操作特征曲线（AUC）下面积评估鉴别力。
所有生物标志物均与临床严重程度和护理路径（仅急诊室、病房入院或 ICU）以及 CT 异常存在相关。GFAP 对预测 CT 异常具有最高的鉴别力（AUC 0.89 [95%CI：0.87-0.90]），与当代决策规则中使用的临床特征相比，更有可能鉴别 CT 阳性患者。在轻度 TBI 患者中，GFAP 也显示出增量诊断价值：当纳入 GFAP 时，其鉴别力从 0.84 [95%CI：0.83-0.86]增加到 0.89 [95%CI：0.87-0.90]。结果在各层和损伤严重程度之间是一致的。与单独使用 GFAP 相比，生物标志物组合并未提高鉴别力。
目前可用的生物标志物反映了损伤严重程度，并且在受伤后 24 小时内测量的血清 GFAP 优于临床特征，可预测 CT 异常。我们的结果支持进一步开发血清 GFAP 检测方法，以在临床实践中实施，这需要强大的临床检测平台。
CENTER-TBI 研究由欧盟第七框架计划（欧盟赠款 602150）支持。
