Lagerstedt Linnéa, Azurmendi Leire, Tenovuo Olli, Katila Ari J, Takala Riikka S K, Blennow Kaj, Newcombe Virginia F J, Maanpää Henna-Riikka, Tallus Jussi, Hossain Iftakher, van Gils Mark, Menon David K, Hutchinson Peter J, Zetterberg Henrik, Posti Jussi P, Sanchez Jean-Charles
Department of Specialities of Internal Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Turku Brain Injury Centre, Turku University Hospital, Turku, Finland.
Front Neurol. 2020 Jun 2;11:376. doi: 10.3389/fneur.2020.00376. eCollection 2020.
Patients with traumatic brain injury (TBI) exhibit a variable and unpredictable outcome. The proteins interleukin 10 (IL-10) and heart fatty acid-binding protein (H-FABP) have shown predictive values for the presence of intracranial lesions. To evaluate the individual and combined outcome prediction ability of IL-10 and H-FABP, and to compare them to the more studied proteins S100β, glial fibrillary acidic protein (GFAP), and neurofilament light (NF-L), both with and without clinical predictors. Blood samples from patients with acute TBI (all severities) were collected <24 h post trauma. The outcome was measured >6 months post injury using the Glasgow Outcome Scale Extended (GOSE) score, dichotomizing patients into: (i) those with favorable (GOSE≥5)/unfavorable outcome (GOSE ≤ 4) and complete (GOSE = 8)/incomplete (GOSE ≤ 7) recovery, and (ii) patients with mild TBI (mTBI) and patients with TBIs of all severities. When sensitivity was set at 95-100%, the proteins' individual specificities remained low. H-FABP showed the best specificity (%) and sensitivity (100%) in predicting complete recovery in patients with mTBI. IL-10 had the best specificity (50%) and sensitivity (96%) in identifying patients with favorable outcome in patients with TBIs of all severities. When individual proteins were combined with clinical parameters, a model including H-FABP, NF-L, and ISS yielded a specificity of 56% and a sensitivity of 96% in predicting complete recovery in patients with mTBI. In predicting favorable outcome, a model consisting IL-10, age, and TBI severity reached a specificity of 80% and a sensitivity of 96% in patients with TBIs of all severities. Combining novel TBI biomarkers H-FABP and IL-10 with GFAP, NF-L and S100β and clinical parameters improves outcome prediction models in TBI.
创伤性脑损伤（TBI）患者的预后具有不确定性和不可预测性。白细胞介素10（IL-10）和心脏脂肪酸结合蛋白（H-FABP）已显示出对颅内病变存在的预测价值。为了评估IL-10和H-FABP的个体及联合预后预测能力，并将它们与研究较多的蛋白质S100β、胶质纤维酸性蛋白（GFAP）和神经丝轻链（NF-L）进行比较，同时考虑有无临床预测指标。收集急性TBI患者（所有严重程度）创伤后<24小时的血样。使用格拉斯哥扩展预后量表（GOSE）评分在伤后>6个月测量预后，将患者分为：（i）预后良好（GOSE≥5）/不良（GOSE≤4）以及完全（GOSE = 8）/不完全（GOSE≤7）恢复的患者，以及（ii）轻度TBI（mTBI）患者和所有严重程度的TBI患者。当敏感性设定为95 - 100%时，这些蛋白质的个体特异性仍然较低。H-FABP在预测mTBI患者完全恢复方面显示出最佳特异性（%）和敏感性（100%）。IL-10在识别所有严重程度的TBI患者中预后良好的患者方面具有最佳特异性（50%）和敏感性（96%）。当个体蛋白质与临床参数相结合时，一个包括H-FABP、NF-L和损伤严重度评分（ISS）的模型在预测mTBI患者完全恢复方面的特异性为56%，敏感性为96%。在预测良好预后方面，一个由IL-10、年龄和TBI严重程度组成的模型在所有严重程度的TBI患者中的特异性达到80%，敏感性为96%。将新型TBI生物标志物H-FABP和IL-10与GFAP、NF-L和S100β以及临床参数相结合可改善TBI的预后预测模型。
