Boucher Valérie, Frenette Jérôme, Neveu Xavier, Tardif Pier-Alexandre, Mercier Éric, Chauny Jean-Marc, Berthelot Simon, Archambault Patrick, Lee Jacques, Perry Jeffrey J, McRae Andrew, Lang Eddy, Moore Lynne, Cameron Peter, Ouellet Marie-Christine, de Guise Elaine, Swaine Bonnie, Émond Marcel, Le Sage Natalie
CHU de Québec-Université Laval Research Centre, 1401, 18e rue, Québec, Québec G1J 1Z4, Canada.
CHU de Québec-Université Laval Research Centre, 1401, 18e rue, Québec, Québec G1J 1Z4, Canada; Faculté de médecine, Université Laval, 1050 Av. de la Médecine, Québec, Québec G1V 0A6, Canada.
J Clin Neurosci. 2023 Dec;118:34-43. doi: 10.1016/j.jocn.2023.10.007. Epub 2023 Oct 17.
Approximately 15 % of individuals who sustained a mild Traumatic Brain Injury (TBI) develop persistent post-concussion symptoms (PPCS). We hypothesized that blood biomarkers drawn in the Emergency Department (ED) could help predict PPCS. The main objective of this project was to measure the association between four biomarkers and PPCS at 90 days post mild TBI. We conducted a prospective cohort study in seven Canadian EDs. Patients aged ≥ 14 years presenting to the ED within 24 h of a mild TBI who were discharged were eligible. Clinical data and blood samples were collected in the ED, and a standardized questionnaire was administered 90 days later to assess the presence of symptoms. The following biomarkers were analyzed: S100B protein, Neuron Specific Enolase (NSE), cleaved-Tau (c-Tau) and Glial Fibrillary Acidic Protein (GFAP). The primary outcome measure was the presence of PPCS at 90 days after trauma. Relative risks and Areas Under the Curve (AUC) were computed. A total of 595 patients were included, and 13.8 % suffered from PPCS at 90 days. The relative risk of PPCS was 0.9 (95 % CI: 0.5-1.8) for S100B ≥ 20 pg/mL, 1.0 (95 % CI: 0.6-1.5) for NSE ≥ 200 pg/mL, 3.4 (95 % CI: 0.5-23.4) for GFAP ≥ 100 pg/mL, and 1.0 (95 % CI: 0.6-1.8) for C-Tau ≥ 1500 pg/mL. AUC were 0.50, 0.50, 0.51 and 0.54, respectively. Among mild TBI patients, S100B protein, NSE, c-Tau or GFAP do not seem to predict PPCS. Future research testing of other biomarkers is needed to determine their usefulness in predicting PPCS.
约15%的轻度创伤性脑损伤（TBI）患者会出现持续性脑震荡后症状（PPCS）。我们假设在急诊科（ED）检测的血液生物标志物有助于预测PPCS。本项目的主要目标是测量轻度TBI后90天时四种生物标志物与PPCS之间的关联。我们在加拿大的七家急诊科进行了一项前瞻性队列研究。年龄≥14岁、在轻度TBI后24小时内到急诊科就诊且已出院的患者符合条件。在急诊科收集临床数据和血液样本，并在90天后进行标准化问卷调查以评估症状的存在情况。分析了以下生物标志物：S100B蛋白、神经元特异性烯醇化酶（NSE）、裂解型Tau蛋白（c-Tau）和胶质纤维酸性蛋白（GFAP）。主要结局指标是创伤后90天时PPCS的存在情况。计算了相对风险和曲线下面积（AUC）。共纳入595例患者，90天时13.8%的患者患有PPCS。S100B≥20 pg/mL时PPCS的相对风险为0.9（95%CI：0.5-1.8），NSE≥200 pg/mL时为1.0（95%CI：0.6-1.5），GFAP≥100 pg/mL时为3.4（95%CI：0.5-23.4），C-Tau≥1500 pg/mL时为1.0（95%CI：0.6-1.8）。AUC分别为0.50、0.50、0.51和0.54。在轻度TBI患者中，S100B蛋白、NSE、c-Tau或GFAP似乎无法预测PPCS。需要进一步研究测试其他生物标志物以确定它们在预测PPCS方面的效用。
