Department of Anesthesiology and Perioperative Medicine, Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, Oregon, USA.
Portland Health Care System, Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, Oregon, USA.
J Neurotrauma. 2021 Sep 15;38(18):2490-2501. doi: 10.1089/neu.2020.7448. Epub 2021 May 27.
Protein biomarkers are often measured at hospital presentation to diagnose traumatic brain injury (TBI) and predict patient outcomes. However, a biomarker measurement at this single time point is no more accurate at predicting patient outcomes than less invasive and more cost-effective methods. Here, we review evidence that TBI biomarkers provide greater prognostic value when measured repeatedly over time, such that a trajectory of biomarker concentrations can be evaluated. PubMed, Google Scholar, and Cochrane Central Register were searched to identify studies from the last decade in which established TBI biomarkers had been measured at more than one time point following acute TBI, and which related their findings to patient outcomes. Twenty-two studies were identified, 18 of which focused on adults and 4 of which focused on children. Three general biomarker trajectories were identified: persistently high, persistently low, and reversal of decreasing concentrations. Downtrend reversal was highly specific to predicting poor patient outcomes. Four studies demonstrated that biomarker trajectories can be affected by therapeutic interventions. Additional studies demonstrated that biomarkers measured at a later time point offered superior prognostic value than a single measurement obtained at initial hospital presentation. Among other details, longitudinal biomarker trajectory assessments may identify ongoing injury and predict patient deterioration before clinical symptoms develop and thus help guide therapeutic interventions.
蛋白质生物标志物通常在医院就诊时进行测量，以诊断创伤性脑损伤 (TBI) 并预测患者的预后。然而，与侵入性更小、成本效益更高的方法相比，在单一时间点测量生物标志物对预测患者预后的准确性并没有提高。在这里，我们回顾了证据，表明当多次重复测量时，TBI 生物标志物提供了更大的预后价值，因此可以评估生物标志物浓度的轨迹。我们在 PubMed、Google Scholar 和 Cochrane Central Register 上进行了搜索，以确定过去十年中在急性 TBI 后至少进行了一次以上测量并将其发现与患者预后相关的已建立的 TBI 生物标志物的研究。确定了 22 项研究，其中 18 项针对成人，4 项针对儿童。确定了三种一般的生物标志物轨迹：持续高、持续低和浓度降低的逆转。下降趋势的逆转对预测患者预后不良具有高度特异性。四项研究表明，生物标志物轨迹可能受到治疗干预的影响。其他研究表明，与初始就诊时单次测量相比，较晚时间点测量的生物标志物提供了更好的预后价值。除了其他细节外，纵向生物标志物轨迹评估可能会识别持续的损伤，并在临床症状出现之前预测患者的恶化，从而有助于指导治疗干预。
