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Biomarkers May Predict Unfavorable Neurological Outcome after Mild Traumatic Brain Injury.
Journal of Neurotrauma ( IF 4.2 ) Pub Date : 2020-12-03 , DOI: 10.1089/neu.2020.7071
Lawrence M Lewis 1 , Linda Papa 2 , Jeffrey J Bazarian 3 , Art Weber 4 , Rob Howard 5 , Robert D Welch 6
Affiliation  

The objective of this study was to determine if initial or repeat measurements of serum concentrations of glial fibrillary acidic protein (GFAP) or ubiquitin C-terminal hydrolase L1 (UCH-L1) are predictive of an acute unfavorable neurological outcome in patients who present to the emergency department (ED) with brain injury and an initial Glasgow Coma Scale Score (GCS) of 14–15. This multi-center observational trial included brain-injured adults presenting to the ED, receiving a head computed tomography (CT) and venipuncture for biomarker concentration measurements within 6 h of injury. Subjects had repeat serum sampling and GCS scores every 4 h for the first 24 h, if available for assessment. We analyzed blood samples using an enzyme-linked immunosorbent assay approved by the Food and Drug Administration (FDA). Wilcoxin two-sample test was used to compare initial and repeat serum concentrations for both biomarkers between CT-positive patients who did not have an acute unfavorable neurological outcome and those patients who did. A total of 145 enrolled subjects had adequate data for analysis; 69 were CT-positive, 74 were CT-negative, and 2 were CT-inconclusive. Five subjects developed an acute unfavorable neurological outcome, defined as need for intracranial pressure monitoring, craniotomy, persistent neurological deficits, or death resulting from brain injury. Initial median serum concentrations of GFAP and UCH-L1 (obtained <6 h from injury) were significantly greater in CT-positive patients who had an acute unfavorable neurological outcome than in CT-positive patients who did not (GFAP: 5237 pg/mL [IQR 4511, 8180] versus 283.5 pg/mL [IQR 107, 1123]; p = 0.026; UCH-L1: 3329 pg/mL [QR 1423, 5010] versus 679.5 pg/mL [IQR 363, 1100] p = 0.014). Repeat serum testing (6- < 12 h from injury) showed that UCH-L1 serum concentration, but not GFAP, was also significantly greater in the acute unfavorable neurological outcome group than in those without an unfavorable outcome: 1088 pg/mL versus 374 pg/mL; p = 0.041.

中文翻译:

生物标志物可预测轻度创伤性脑损伤后不利的神经学结果。

本研究的目的是确定初次或重复测量胶质纤维酸性蛋白 (GFAP) 或泛素 C 端水解酶 L1 (UCH-L1) 的血清浓度是否可预测出现在急诊科 (ED) 脑损伤和初始格拉斯哥昏迷量表评分 (GCS) 为 14-15。这项多中心观察性试验包括到 ED 就诊的脑损伤成人,接受头部计算机断层扫描 (CT) 和静脉穿刺以在受伤后 6 小时内测量生物标志物浓度。如果可用于评估,受试者在前 24 小时内每 4 小时重复一次血清采样和 GCS 评分。我们使用食品和药物管理局 (FDA) 批准的酶联免疫吸附测定法分析了血液样本。Wilcoxin 双样本测试用于比较没有急性不利神经系统结果的 CT 阳性患者和有的患者之间两种生物标志物的初始和重复血清浓度。共有 145 名登记受试者有足够的数据进行分析;69 例 CT 阳性,7​​4 例 CT 阴性,2 例 CT 不确定。五名受试者出现急性不良神经系统结果,定义为需要颅内压监测、开颅手术、持续性神经功能缺损或因脑损伤导致死亡。CT 阳性患者的初始血清中 GFAP 和 UCH-L1 浓度(在受伤后 6 小时内获得)显着高于没有出现急性不良神经系统结局的 CT 阳性患者(GFAP:5237 pg/mL [ IQR 4511, 8180] 与 283.5 pg/mL [IQR 107, 1123];p  = 0.026;UCH-L1:3329 pg/mL [QR 1423, 5010] 与 679.5 pg/mL [IQR 363, 1100] p  = 0.014)。重复血清测试(受伤后 6- < 12 小时)显示,急性不利神经系统结果组的 UCH-L1 血清浓度(而非 GFAP)也显着高于无不利结果组:1088 pg/mL 对 374 pg /毫升;p  = 0.041。
更新日期:2020-12-15
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