Loyola University Medical Center, Department of Neurological Surgery, USA.
Midwestern University Chicago, College of Osteopathic Medicine, USA.
Clin Neurol Neurosurg. 2024 Jul;242:108312. doi: 10.1016/j.clineuro.2024.108312. Epub 2024 Apr 30.
Severe traumatic brain injury (TBI) presentation and late clinical outcomes are usually evaluated by the Glasgow Outcome Scale-Extended (GOS-E), which lacks strong prognostic predictability. Several blood biomarkers have been linked to TBI, such as Tau, GFAP, UCH-L1, S-100B, and NSE. Clinical values of TBI biomarkers have yet to be evaluated in a focused multi-study meta-analysis. We reviewed relevant articles evaluating potential relationships between TBI biomarkers and both early and 6-month outcomes.
All PubMed article publications from January 2000 to November 2023 with the search criteria "Protein Biomarker" AND "Traumatic Brain Injury" were included. Amongst all comparative studies, the sensitivity means and range values of biomarkers in predicting CT Rotterdam scores, ICU admission in the early period, or predicting GOS-E < 4 at the 6-month period were calculated from confusion matrices. Sensitivity values were modeled for each biomarker across studies and compared statistically for heterogeneity and differences.
From the 65 articles that met the criteria, 13 were included in this study. Six articles involved early-period TBI outcomes and seven involved 6-month outcomes. In the early period TBI outcomes, GFAP had a superior sensitivity to UCH-L1 and S-100B, and similar sensitivity to the CT Rotterdam score. In the 6-month period TBI outcomes, total Tau and NSE both had significant interstudy heterogeneity, making them inferior to GFAP, phosphorylated Tau, UCH-L1, and S-100B, all four of which had similar sensitivities at 75 %. This sensitivity range at 6-month outcomes was still relatively inferior to the CT Rotterdam score. Total Tau did not show any prognostic advantage at six months with GOS-E < 4, and phosphorylated Tau was similar in its sensitivity to other biomarkers such as GFAP and UCH-L1 and still inferior to the CT Rotterdam score.
This data suggests that TBI protein biomarkers do not possess better prognostic value with regards to outcomes.
严重创伤性脑损伤（TBI）的表现和晚期临床结果通常通过格拉斯哥结局量表扩展版（GOS-E）进行评估，但该量表缺乏较强的预后预测能力。几种血液生物标志物与 TBI 相关，如 Tau、GFAP、UCH-L1、S-100B 和 NSE。TBI 生物标志物的临床价值尚未在集中的多研究荟萃分析中进行评估。我们回顾了评估 TBI 生物标志物与早期和 6 个月结局之间潜在关系的相关文章。
纳入了所有从 2000 年 1 月至 2023 年 11 月使用“蛋白质生物标志物”和“创伤性脑损伤”搜索标准的 PubMed 文章出版物。在所有比较研究中，从混淆矩阵中计算了生物标志物在预测 CT 鹿特丹评分、早期 ICU 入院或预测 6 个月时 GOS-E < 4 方面的敏感性均值和范围值。针对每个生物标志物在研究之间进行了模型化，并针对异质性和差异进行了统计学比较。
从符合标准的 65 篇文章中，有 13 篇被纳入本研究。6 篇文章涉及早期 TBI 结局，7 篇文章涉及 6 个月结局。在早期 TBI 结局中，GFAP 的敏感性优于 UCH-L1 和 S-100B，与 CT 鹿特丹评分的敏感性相当。在 6 个月 TBI 结局中，总 Tau 和 NSE 均存在显著的研究间异质性，使其敏感性低于 GFAP、磷酸化 Tau、UCH-L1 和 S-100B，后四种标志物的敏感性均在 75%左右。这种敏感性范围在 6 个月的结局中仍然相对低于 CT 鹿特丹评分。总 Tau 在 6 个月时与 GOS-E < 4 没有表现出任何预后优势，磷酸化 Tau 的敏感性与 GFAP 和 UCH-L1 等其他标志物相似，仍低于 CT 鹿特丹评分。
这些数据表明，TBI 蛋白生物标志物在预后方面并没有更好的预测价值。
