Department of Clinical Medicine, Dalian Medical University, Dalian, Liaoning, China.
Department of Neurosurgery, Clinical Medical College of Yangzhou University, No.98 Nantong Westroad, Yangzhou, 225001, Jiangsu, China.
Eur J Trauma Emerg Surg. 2023 Jun;49(3):1235-1246. doi: 10.1007/s00068-022-01979-y. Epub 2022 May 7.
Over the years, blood biomarkers have been extensively applied for diagnostic and prognostic assessment of traumatic brain injury (TBI). Herein, we conducted a meta-analysis to evaluate the diagnostic and prognostic value of glial fibrillary acidic protein (GFAP) for TBI patients.
The online databases, including PubMed, Embase, Cochrane Library, CNKI, and WFSD, were systematically retrieved from inception until May 2021. The RevMan 5.3 software and Stata 15 were used to conduct data analysis.
A total of 22 eligible studies comprising 3709 patients were included in this meta-analysis. The pooled results indicated that serum GFAP had a diagnostic value in detecting traumatic intracranial lesions (AUC 0.81; 95% CI 0.77-0.84; p < 0.00001). The pooled sensitivity and specificity were 0.93 (95% CI 0.81-0.98), and 0.66 (95% 0.53-0.77; p < 0.00001), respectively. For assessment of unfavorable outcome, the pooled sensitivity, specificity and AUC value were 0.66 (95% CI 0.54-0.76; p < 0.00001), 0.82(95% CI 0.72-0.90; p < 0.00001), and 0.82 (95% CI 0.76-0.88; p < 0.00001), respectively. Besides, GFAP exhibited a significant value in predicting mortality (AUC 0.81; 95% CI 0.77-0.84; p < 0.00001), with high sensitivity and specificity (0.86, 95% CI 0.79-0.92, p < 0.00001, and 0.66, 95% CI 0.52-0.77, p < 0.00001). The subgroup analysis indicated that the type of TBI and cut-off value were potential sources of heterogeneity, which influenced the pooled AUC values for mortality prediction.
Our meta-analysis indicated that GFAP had diagnostic and prognostic value for TBI patients, especially during the early TBI.
多年来，血液生物标志物已被广泛应用于创伤性脑损伤（TBI）的诊断和预后评估。在此，我们进行了一项荟萃分析，以评估胶质纤维酸性蛋白（GFAP）对 TBI 患者的诊断和预后价值。
系统检索了包括 PubMed、Embase、Cochrane 图书馆、CNKI 和 WFSD 在内的在线数据库，检索时间从建库至 2021 年 5 月。使用 RevMan 5.3 软件和 Stata 15 进行数据分析。
共有 22 项符合纳入标准的研究，包含 3709 例患者纳入了本荟萃分析。汇总结果表明，血清 GFAP 对检测创伤性颅内病变具有诊断价值（AUC 0.81；95%CI 0.77-0.84；p<0.00001）。汇总的敏感性和特异性分别为 0.93（95%CI 0.81-0.98）和 0.66（95%CI 0.53-0.77；p<0.00001）。对于不良预后的评估，汇总的敏感性、特异性和 AUC 值分别为 0.66（95%CI 0.54-0.76；p<0.00001）、0.82（95%CI 0.72-0.90；p<0.00001）和 0.82（95%CI 0.76-0.88；p<0.00001）。此外，GFAP 在预测死亡率方面也具有显著意义（AUC 0.81；95%CI 0.77-0.84；p<0.00001），具有较高的敏感性和特异性（0.86，95%CI 0.79-0.92，p<0.00001，和 0.66，95%CI 0.52-0.77，p<0.00001）。亚组分析表明，TBI 类型和截断值是异质性的潜在来源，影响了死亡率预测的汇总 AUC 值。
本荟萃分析表明，GFAP 对 TBI 患者具有诊断和预后价值，尤其是在早期 TBI 中。
