Formisano Rita, D'Ippolito Mariagrazia, Giustini Marco, Catani Sheila, Mondello Stefania, Piccolino Iliana, Iannuzzi Filomena, Wang Kevin K, Hayes Ronald L
Neurorehabilitation 2, Post-Coma Unit, IRCCS Fondazione Santa Lucia, 00179 Rome, Italy.
Environmental and Social Epidemiology Unit, National Institute of Health, 00161 Rome, Italy.
Brain Sci. 2024 Feb 29;14(3):239. doi: 10.3390/brainsci14030239.
Serum biomarkers, such as Neurofilament Light (NF-L), Glial Fibrillary Acidic Protein (GFAP), Ubiquitin C-terminal Hydrolase (UCH-L1), and Total-tau (T-Tau) have been proposed for outcome prediction in the acute phase of severe traumatic brain injury, but they have been less investigated in patients with prolonged DoC (p-DoC).
We enrolled 25 p-DoC patients according to the Coma Recovery Scale-Revised (CRS-R). We identified different time points: injury onset (t), first blood sampling at admission in Neurorehabilitation (t), and second blood sampling at discharge (t). Patients were split into improved (improved level of consciousness from t to t) and not-improved (unchanged or worsened level of consciousness from t to t).
All biomarker levels decreased over time, even though each biomarker reveals typical features. Serum GFAP showed a weak correlation between t and t ( = 0.001), while no correlation was observed for serum NF-L ( = 0.955), UCH-L1 ( = 0.693), and T-Tau ( = 0.535) between t and t. Improved patients showed a significant decrease in the level of NF-L ( = 0.0001), UCH-L1 ( = 0.001), and T-Tau ( = 0.002), but not for serum GFAP ( = 0.283). No significant statistical differences were observed in the not-improved group.
A significant correlation was found between the level of consciousness improvement and decreased NF-L, UCH-L1, and T-Tau levels. Future studies on the association of serum biomarkers with neurophysiological and neuroimaging prognostic indicators are recommended.
血清生物标志物，如神经丝轻链（NF-L）、胶质纤维酸性蛋白（GFAP）、泛素羧基末端水解酶（UCH-L1）和总tau蛋白（T-Tau），已被提出用于预测重度创伤性脑损伤急性期的预后，但在持续性植物状态（p-DoC）患者中的研究较少。
我们根据修订的昏迷恢复量表（CRS-R）纳入了25例p-DoC患者。我们确定了不同的时间点：受伤时（t）、神经康复入院时首次采血时（t）和出院时第二次采血时（t）。患者被分为意识改善组（从t到t意识水平改善）和未改善组（从t到t意识水平无变化或恶化）。
尽管每种生物标志物都有其典型特征，但所有生物标志物水平均随时间下降。血清GFAP在t和t之间显示出弱相关性（=0.001），而血清NF-L（=0.955）、UCH-L1（=0.693）和T-Tau（=0.535）在t和t之间未观察到相关性。意识改善的患者NF-L（=0.0001）、UCH-L1（=0.001）和T-Tau（=0.002）水平显著下降，但血清GFAP水平未下降（=0.283）。未改善组未观察到显著的统计学差异。
意识改善水平与NF-L、UCH-L1和T-Tau水平降低之间存在显著相关性。建议未来开展关于血清生物标志物与神经生理和神经影像预后指标关联的研究。
