Protein biomarkers are often measured at hospital presentation to diagnose traumatic brain injury (TBI) and predict patient outcomes. However, a biomarker measurement at this single time point is no more accurate at predicting patient outcomes than less invasive and more cost-effective methods. Here, we review evidence that TBI biomarkers provide greater prognostic value when measured repeatedly over time, such that a trajectory of biomarker concentrations can be evaluated. PubMed, Google Scholar, and Cochrane Central Register were searched to identify studies from the last decade in which established TBI biomarkers had been measured at more than one time point following acute TBI, and which related their findings to patient outcomes. Twenty-two studies were identified, 18 of which focused on adults and 4 of which focused on children. Three general biomarker trajectories were identified: persistently high, persistently low, and reversal of decreasing concentrations. Downtrend reversal was highly specific to predicting poor patient outcomes. Four studies demonstrated that biomarker trajectories can be affected by therapeutic interventions. Additional studies demonstrated that biomarkers measured at a later time point offered superior prognostic value than a single measurement obtained at initial hospital presentation. Among other details, longitudinal biomarker trajectory assessments may identify ongoing injury and predict patient deterioration before clinical symptoms develop and thus help guide therapeutic interventions.

中文翻译：

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用于预测临床结果的创伤性脑损伤生物标志物的纵向过程：综述


通常在医院就诊时测量蛋白质生物标志物，以诊断创伤性脑损伤 (TBI) 并预测患者的预后。然而，在这个单一时间点的生物标志物测量在预测患者结果方面并不比侵入性较小且更具成本效益的方法更准确。在这里，我们回顾了证据，表明随着时间的推移重复测量，TBI 生物标志物可以提供更大的预后价值，从而可以评估生物标志物浓度的轨迹。检索了 PubMed、Google Scholar 和 Cochrane Central Register，以识别过去十年的研究，这些研究在急性 TBI 后的多个时间点对已建立的 TBI 生物标志物进行了测量，并将其研究结果与患者结果相关联。确定了 22 项研究，其中 18 项针对成人，4 项针对儿童。确定了三种一般生物标志物轨迹：持续高、持续低和浓度下降逆转。下降趋势逆转对于预测不良患者预后具有高度特异性。四项研究表明，生物标志物轨迹可能受到治疗干预的影响。其他研究表明，在较晚的时间点测量的生物标志物比在最初医院就诊时获得的单一测量结果具有更好的预后价值。除其他细节外，纵向生物标志物轨迹评估可以识别持续的损伤并在临床症状出现之前预测患者的病情恶化，从而有助于指导治疗干预措施。