血清生物标志物水平在创伤性脑损伤中有附加和累积的预后价值。
Admission levels of serum biomarkers have additive and cumulative prognostic value in traumatic brain injury.
机构信息
Department of Clinical Biochemistry, Aarhus University Hospital, 8200, Aarhus, Denmark.
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
出版信息
Sci Rep. 2024 Jun 19;14(1):14139. doi: 10.1038/s41598-024-64125-1.
Elevated levels of CNS-derived serum proteins are associated with poor outcome in traumatic brain injury (TBI), but the value of adding acute serum biomarker levels to common clinical outcome predictors lacks evaluation. We analyzed admission serum samples for Total-Tau (T-Tau), Neurofilament light chain (Nfl), Glial fibrillary acidic protein (GFAP), and Ubiquitin C-terminal hydrolase L1 (UCHL1) in a cohort of 396 trauma patients including 240 patients with TBI. We assessed the independent association of biomarkers with 1-year mortality and 6-12 months Glasgow Outcome Scale Extended (GOSE) score, as well as the additive and cumulative value of biomarkers on Glasgow Coma Scale (GCS) and Marshall Score for outcome prediction. Nfl and T-Tau levels were independently associated with outcome (OR: Nfl = 1.65, p = 0.01; T-Tau = 1.99, p < 0.01). Nfl or T-Tau improved outcome prediction by GCS (Wald Chi, Nfl = 6.8-8.8, p < 0.01; T-Tau 7.2-11.3, p < 0.01) and the Marshall score (Wald Chi, Nfl = 16.2-17.5, p < 0.01; T-Tau 8.7-12.4, p < 0.01). Adding T-Tau atop Nfl further improved outcome prediction in majority of tested models (Wald Chi range 3.8-9.4, p ≤ 0.05). Our data suggest that acute levels of serum biomarkers are independently associated with outcome after TBI and add outcome predictive value to commonly used clinical scores.
中枢神经系统来源的血清蛋白水平升高与创伤性脑损伤(TBI)的预后不良相关,但评估急性血清生物标志物水平对常见临床预后预测因子的附加价值仍缺乏研究。我们分析了包括 240 例 TBI 患者在内的 396 例创伤患者入院时的血清总 Tau(T-Tau)、神经丝轻链(Nfl)、神经胶质纤维酸性蛋白(GFAP)和泛素 C 端水解酶 L1(UCHL1)水平。我们评估了生物标志物与 1 年死亡率和 6-12 个月格拉斯哥结局量表扩展(GOSE)评分的独立相关性,以及生物标志物对格拉斯哥昏迷量表(GCS)和 Marshall 评分的附加和累积价值对预后的预测作用。Nfl 和 T-Tau 水平与结局独立相关(OR:Nfl=1.65,p=0.01;T-Tau=1.99,p<0.01)。Nfl 或 T-Tau 可改善 GCS(Wald Chi,Nfl=6.8-8.8,p<0.01;T-Tau=7.2-11.3,p<0.01)和 Marshall 评分(Wald Chi,Nfl=16.2-17.5,p<0.01;T-Tau=8.7-12.4,p<0.01)对结局的预测。在大多数测试模型中,T-Tau 与 Nfl 联合应用可进一步提高结局预测(Wald Chi 范围 3.8-9.4,p≤0.05)。我们的数据表明,TBI 后血清生物标志物的急性水平与结局独立相关,并为常用的临床评分增加了结局预测价值。