Elevated levels of serum glial fibrillary acidic protein breakdown products in mild and moderate traumatic brain injury are associated with intracranial lesions and neurosurgical intervention

Autor: Linnet Akinyi, Kara Schmid, Ming Cheng Liu, Frank C. Tortella, Jay L. Falk, Neha K. Dixit, Ronald L. Hayes, Philip Giordano, Zhiqun Zhang, Jason A. Demery, Salvatore Silvestri, Claudia S. Robertson, Stefania Mondello, Gretchen M. Brophy, Ian Ferguson, Jixiang Mo, Kevin K.W. Wang, Lawrence M. Lewis, Linda Papa
Rok vydání: 2011
Předmět:
Serum
Adult
Male
medicine.medical_specialty
Traumatic Brain Injury
Adolescent
Traumatic brain injury
Amnesia
Poison control
diagnostic
specificity
Article
Head trauma
Young Adult
proteomics
Computed Tomography
Trauma Centers
Glial Fibrillary Acidic Protein
medicine
Humans
Glasgow Coma Scale
human
Prospective Studies
Prospective cohort study
Traumatic Brain Injury
head injury
trauma
human
biomarkers
proteomics
diagnostic
Serum
Computed Tomography
neurosurgical intervention
sensitivity
specificity
Aged
Aged
80 and over
Receiver operating characteristic
business.industry
Area under the curve
biomarkers
Brain
Middle Aged
medicine.disease
sensitivity
Surgery
trauma
ROC Curve
Brain Injuries
Case-Control Studies
Emergency Medicine
neurosurgical intervention
Female
medicine.symptom
business
head injury
Zdroj: Annals of emergency medicine. 59(6)
ISSN: 1097-6760
Popis: Study objective This study examines whether serum levels of glial fibrillary acidic protein breakdown products (GFAP-BDP) are elevated in patients with mild and moderate traumatic brain injury compared with controls and whether they are associated with traumatic intracranial lesions on computed tomography (CT) scan (positive CT result) and with having a neurosurgical intervention. Methods This prospective cohort study enrolled adult patients presenting to 3 Level I trauma centers after blunt head trauma with loss of consciousness, amnesia, or disorientation and a Glasgow Coma Scale (GCS) score of 9 to 15. Control groups included normal uninjured controls and trauma controls presenting to the emergency department with orthopedic injuries or a motor vehicle crash without traumatic brain injury. Blood samples were obtained in all patients within 4 hours of injury and measured by enzyme-linked immunosorbent assay for GFAP-BDP (nanograms/milliliter). Results Of the 307 patients enrolled, 108 were patients with traumatic brain injury (97 with GCS score 13 to 15 and 11 with GCS score 9 to 12) and 199 were controls (176 normal controls and 16 motor vehicle crash controls and 7 orthopedic controls). Receiver operating characteristic curves demonstrated that early GFAP-BDP levels were able to distinguish patients with traumatic brain injury from uninjured controls with an area under the curve of 0.90 (95% confidence interval [CI] 0.86 to 0.94) and differentiated traumatic brain injury with a GCS score of 15 with an area under the curve of 0.88 (95% CI 0.82 to 0.93). Thirty-two patients with traumatic brain injury (30%) had lesions on CT. The area under these curves for discriminating patients with CT lesions versus those without CT lesions was 0.79 (95% CI 0.69 to 0.89). Moreover, the receiver operating characteristic curve for distinguishing neurosurgical intervention from no neurosurgical intervention yielded an area under the curve of 0.87 (95% CI 0.77 to 0.96). Conclusion GFAP-BDP is detectable in serum within an hour of injury and is associated with measures of injury severity, including the GCS score, CT lesions, and neurosurgical intervention. Further study is required to validate these findings before clinical application.
Databáze: OpenAIRE
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