Incremental prognostic value of acute serum biomarkers for functional outcome after traumatic brain injury (CENTER-TBI): an observational cohort study

Helmrich, Isabel R.A. Retel; Czeiter, Endre; Amrein, Krisztina; Büki, András; Lingsma, Hester F.; Menon, David; Mondello, Stefania; Steinbüchel, Nicole von; Wang, Kevin; Wilson, Lindsay; Xu, Haiyan; Yang, Zhihui; Klaveren, David van; Maas, Andrew I.R.

doi:10.1016/s1474-4422(22)00218-6

Cited by 53 publications

(50 citation statements)

References 32 publications

(43 reference statements)

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“…It is certainly conceivable that predicting outcome after acute SCI may be facilitated by combining fluid biomarkers with clinical information and imaging biomarkers (e.g., MRI), a combinatorial approach that has shown promise in predicting outcome after TBI. 12 , 27 - 30 As we demonstrate, the serum biomarker predictions of conversion in AIS A patients or the AIS grade outcome (AIS A/B vs AIS C/D) at 6 months postinjury are improved with knowledge of baseline clinical parameters such as the sensory ZPP and baseline AIS grade. Although this shows that superior prognostication may be achieved by adding the neurologic examination, this clinical assessment is frequently impossible to perform or is quite unreliable in the acute setting.…”

Section: Discussionmentioning

confidence: 76%

Association of CSF and Serum Neurofilament Light and Glial Fibrillary Acidic Protein, Injury Severity, and Outcome in Spinal Cord Injury

et al. 2023

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Background and Objective:Traumatic spinal cord injury (SCI) is highly heterogenous and tools to better delineate pathophysiology and recovery are needed. Our objective was to profile the response of two biomarkers, neurofilament light (NF-L) and glial fibrillary acidic protein (GFAP), in the serum and CSF of acute SCI patients to evaluate their ability to objectively characterize injury severity and predict neurologic recovery.Methods:Blood and CSF samples were obtained from prospectively enrolled acute SCI patients through days 1-4 post-injury, and the concentration of NF-L and GFAP was quantified using SimoaTMtechnology. Neurologic assessments defined the ASIA Impairment Scale (AIS) grade and motor score (MS) at presentation and 6-months post-injury.Results:118 acute SCI patients (78 AIS A, 20 AIS B, 20 AIS C) were enrolled with 113 (96%) completing 6-month follow-up. NF-L and GFAP levels were strongly associated between paired serum and CSF specimens, increased with injury severity, and distinguished among baseline AIS grades. Serum NF-L and GFAP were significantly (P=0.02 to <0.0001) higher in AIS A patients who did not improve at 6-months, predicting AIS grade conversion with a sensitivity and specificity (95% confidence interval) of 76% (61, 87) and 77% (55, 92) using NF-L, and 72% (57, 84) and 77% (55, 92) using GFAP at 72h, respectively. Independent of clinical baseline assessment, a serum NF-L threshold of 170 pg/ml at 72h predicted those patients who would be classified as “motor complete” (AIS A/B) compared to “motor incomplete” (AIS C/D) at 6 months with a sensitivity of 87% (76, 94) and specificity of 84% (69, 94); a serum GFAP threshold of 13,180 pg/ml at 72h yielded a sensitivity of 90% (80, 96) and specificity of 84% (69, 94).Discussion:The potential for NF-L and GFAP to classify injury severity and predict outcome after acute SCI will be useful for patient stratification and prognostication in clinical trials, and inform communication of prognosis.Trial Registration Information:Registered on ClinicalTrials.gov:NCT00135278(Mar 2006) andNCT01279811(Jan 2012).

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Section: Discussionmentioning

confidence: 76%

Association of CSF and Serum Neurofilament Light and Glial Fibrillary Acidic Protein, Injury Severity, and Outcome in Spinal Cord Injury

et al. 2023

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“…- Biomarkers linked to brain damage: The marker S100B has been used in multiple studies due to its relationship with the prognosis of TBI ( 13 ), and other markers such as UCHL1, NSE, and GFAP levels have been associated with the onset of complications in TBI ( 14 ). We obtained the values of these markers at 6 h and 12 h after the TBI, as they are the minimum observation times at our center.…”

Section: Methodsmentioning

confidence: 99%

Platelet levels and age are determinants of survival after mild–moderate TBI: A prospective study in Spain

Yuguero

Vena

Bernal

et al. 2023

Front. Public Health

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IntroductionTraumatic brain injury (TBI) is a very important reason for consultation in emergency departments.MethodsA hospital cohort study with patients who attended a hospital emergency department between June 1, 2018 and December 31, 2020 due to TBI was studied. Clinical and sociodemographic variables were recorded. The levels of biomarkers and management variables were used. Qualitative variables were analyzed using Pearson's chi-square test, and quantitative variables using the Mann–Whitney U-test. Survival analyses were performed by fitting a multivariable Cox regression model for patient survival during the follow-up of the study in relation to the patient's characteristics upon admission to the emergency department.ResultsA total of 540 patients were included. The mean age was 83 years, and 53.9% of the patients were men. Overall, 112 patients (20.7%) died during the study follow-up. The mortality rate per 100 person-years was 14.33 (11.8–17.24), the most frequent mechanism being falls in the home, with none caused on public roads. The multivariable Cox proportional hazards model showed that survival after TBI was significantly associated with age, S100 levels, Charlson index, patient's institutionalized status, the place where the TBI occurred, and hemoglobin and platelet levels.DiscussionThe most common profile for a patient with a TBI was male and aged between 80 and 90 years. The combination of the variables age, Charlson index, place of TBI occurrence, and hemoglobin and platelet levels could offer early prediction of survival in our population independently of TBI severity. With the data obtained, a therapeutic algorithm could be established for patients suffering from mild TBI, allowing the patient to be supervised at home, avoiding futile referrals to emergency services.

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“…The prognostic value of a number of biomarkers has also been investigated including: glial fibrillary acidic protein; S100 calcium-binding protein B; total s; neurofilament protein-light; neuron-specific enolase; and ubiquitin C-terminal hydrolase L1. It is possible that the addition of these to existing models will help improve their prognostic value [62].…”

Section: Prognosticationmentioning

confidence: 99%

Management of traumatic brain injury in the non‐neurosurgical intensive care unit: a narrative review of current evidence

et al. 2023

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Each year, approximately 70 million people suffer traumatic brain injury, which has a significant physical, psychosocial and economic impact for patients and their families. It is recommended in the UK that all patients with traumatic brain injury and a Glasgow coma scale ≤ 8 should be transferred to a neurosurgical centre. However, many patients, especially those in whom neurosurgery is not required, are not treated in, nor transferred to, a neurosurgical centre. This review aims to provide clinicians who work in non-neurosurgical centres with a summary of contemporary studies relevant to the critical care management of patients with traumatic brain injury. A targeted literature review was undertaken that included guidelines, systematic reviews, meta-analyses, clinical trials and randomised controlled trials (published in English between 1 January 2017 and 1 July 2022). Studies involving key clinical management strategies published before this time, but which have not been updated or repeated, were also eligible for inclusion. Analysis of the topics identified during the review was then summarised. These included: fundamental critical care management approaches (including ventilation strategies, fluid management, seizure control and osmotherapy); use of processed electroencephalogram monitoring; non-invasive assessment of intracranial pressure; prognostication; and rehabilitation techniques. Through this process, we have formulated practical recommendations to guide clinical practice in non-specialist centres.

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Incremental prognostic value of acute serum biomarkers for functional outcome after traumatic brain injury (CENTER-TBI): an observational cohort study

Cited by 53 publications

References 32 publications

Association of CSF and Serum Neurofilament Light and Glial Fibrillary Acidic Protein, Injury Severity, and Outcome in Spinal Cord Injury

Association of CSF and Serum Neurofilament Light and Glial Fibrillary Acidic Protein, Injury Severity, and Outcome in Spinal Cord Injury

Platelet levels and age are determinants of survival after mild–moderate TBI: A prospective study in Spain

Management of traumatic brain injury in the non‐neurosurgical intensive care unit: a narrative review of current evidence

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