血液酒精对胶质纤维酸性蛋白和泛素羧基末端水解酶L1诊断创伤性颅内出血准确性的影响：一项TRACK-TBI研究。

Effect of blood alcohol on the diagnostic accuracy of glial fibrillary acidic protein and ubiquitin carboxy-terminal hydrolase L1 for traumatic intracranial hemorrhage: A TRACK-TBI study.

作者信息

Harris Mark, Yue John K, Jain Sonia, Sun Xiaoying, Puccio Ava M, Gardner Raquel C, Wang Kevin K W, Okonkwo David O, Yuh Esther L, Mukherjee Pratik, Nelson Lindsay D, Taylor Sabrina R, Markowitz Amy J, Diaz-Arrastia Ramon, Manley Geoffrey T, Korley Frederick K

机构信息

Department of Neurological Surgery, University of California, Irvine, Irvine, California, USA.

Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.

出版信息

Acad Emerg Med. 2025 Jul;32(7):748-758. doi: 10.1111/acem.15109. Epub 2025 Feb 18.

DOI:10.1111/acem.15109

PMID:39967286

Abstract

BACKGROUND

Acute intoxication is common in patients evaluated for traumatic brain injury (TBI). However, the effect of elevated blood alcohol levels (BALs) on the diagnostic accuracy of FDA-cleared biomarkers for evaluating traumatic intracranial injury on computed tomography (CT) scan, namely, glial fibrillary acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), has not been well studied.

METHODS

We investigated the effect of significantly elevated (>300 mg/dL) and modestly elevated BAL (81-300 mg/dL) at emergency department presentation on the diagnostic accuracy of GFAP and UCH-L1 for predicting a positive CT in patients presenting to 18 U.S. Level I trauma centers within 24 h of TBI as part of the prospective, Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study. Plasma GFAP and UCH-L1 were measured using Abbott i-STAT Alinity and ARCHITECT assays. Discrimination was evaluated using the area under the receiver operating characteristic curve (AUC).

RESULTS

Of 2320 TRACK-TBI participants studied, 54 (2.3%), 332 (14.3%), 1209 (52.1%), and 725 (31.3%) had significantly elevated BAL, modestly elevated BAL, nonelevated BAL (0-80 mg/dL), and no BAL available, respectively; 48.3% of the cohort had a positive brain CT. Those with significantly elevated and modestly elevated BAL were more likely to have positive CT (61.1% and 60.5% vs. 46.9% and 44.0%) and had higher plasma GFAP and UCH-L1 levels than those with nonelevated BAL and no BAL available. The AUC of GFAP and UCH-L1 combined for predicting CT positivity was higher in those with significantly elevated BAL (0.949) than those with modestly elevated BAL (0.858), nonelevated BAL (0.849), and no BAL available (0.883).

CONCLUSIONS

Modestly and significantly elevated BAL does not lower the diagnostic accuracy of GFAP and UCH-L1 for predicting traumatic intracranial injury on CT. These biomarkers may be useful in decreasing avoidable brain CT imaging in persons with acute alcohol intoxication.

摘要

背景

在因创伤性脑损伤（TBI）接受评估的患者中，急性中毒很常见。然而，血液酒精水平（BAL）升高对美国食品药品监督管理局（FDA）批准的用于在计算机断层扫描（CT）上评估创伤性颅内损伤的生物标志物（即胶质纤维酸性蛋白（GFAP）和泛素羧基末端水解酶L1（UCH-L1））的诊断准确性的影响尚未得到充分研究。

方法

作为前瞻性的“TBI转化研究与临床知识”（TRACK-TBI）研究的一部分，我们调查了急诊科就诊时BAL显著升高（>300mg/dL）和中度升高（81-300mg/dL）对GFAP和UCH-L1在TBI后24小时内就诊于18家美国一级创伤中心的患者中预测CT阳性的诊断准确性的影响。使用雅培i-STAT Alinity和ARCHITECT检测法测量血浆GFAP和UCH-L1。使用受试者操作特征曲线（AUC）下的面积评估辨别力。

结果

在2320名参与TRACK-TBI研究的受试者中，分别有54名（2.3%）、332名（14.3%）、1209名（52.1%）和725名（31.3%）的BAL显著升高、中度升高、未升高（0-80mg/dL）以及无法获得BAL数据；该队列中有48.3%的患者脑部CT呈阳性。BAL显著升高和中度升高的患者更有可能CT呈阳性（分别为61.1%和60.5%，而未升高BAL和无BAL数据的患者为46.9%和44.0%），并且其血浆GFAP和UCH-L1水平高于未升高BAL和无BAL数据的患者。BAL显著升高的患者中，GFAP和UCH-L1联合预测CT阳性的AUC（0.949）高于BAL中度升高（0.858）、未升高BAL（0.849）和无BAL数据（0.883）的患者。