TY - JOUR
T1 - Glial Fibrillary Acidic Protein (GFAP) Outperforms S100 Calcium-Binding Protein B (S100B) and Ubiquitin C-Terminal Hydrolase L1 (UCH-L1) as Predictor for Positive Computed Tomography of the Head in Trauma Subjects
AU - Mahan, Margaret Y.
AU - Thorpe, Maxwell
AU - Ahmadi, A.
AU - Abdallah, Tessneem
AU - Casey, Hannah
AU - Sturtevant, D.
AU - Judge-Yoakam, Sénait
AU - Hoover, C.
AU - Rafter, Daniel
AU - Miner, James R
AU - Richardson, Chad
AU - Samadani, Uzma
PY - 2019/8
Y1 - 2019/8
N2 - Objective: Traumatic brain injuries (TBIs) are largely underdiagnosed and may have persistent refractory consequences. Current assessments for acute TBI are limited to physical examination and imaging. Biomarkers such as glial fibrillary acidic protein (GFAP), ubiquitin C-terminal hydrolase L1 (UCH-L1), and S100 calcium-binding protein B (S100B) have shown predictive value as indicators of TBI and potential screening tools. Methods: In total, 37 controls and 118 unique trauma subjects who received a clinically ordered head computed tomography (CT) in the emergency department of a level 1 trauma center were evaluated. Blood samples collected at 0–8 hours (initial) and 12–32 hours (delayed) postinjury were analyzed for GFAP, UCH-L1, and S100B concentrations. These were then compared in CT-negative and CT-positive subjects. Results: Median GFAP, UCH-L1, and S100B concentrations were greater in CT-positive subjects at both timepoints compared with CT-negative subjects. In addition, median UCH-L1 and S100B concentrations were lower at the delayed timepoint, whereas median GFAP concentrations were increased. As predictors of a positive CT of the head, GFAP outperformed UCH-L1 and S100B at both timepoints (initial: 0.89 sensitivity, 0.62 specificity; delayed: 0.94 sensitivity, 0.67 specificity). GFAP alone also outperformed all possible combinations of biomarkers. Conclusions: GFAP, UCH-L1, and S100B demonstrated utility for rapid prediction of a CT-positive TBI within 0–8 hours of injury. GFAP exhibited the greatest predictive power at 12–32 hours. Furthermore, these results suggest that GFAP alone has greater utility for predicting a positive CT of the head than UCH-L1, S100B, or any combination of the 3.
AB - Objective: Traumatic brain injuries (TBIs) are largely underdiagnosed and may have persistent refractory consequences. Current assessments for acute TBI are limited to physical examination and imaging. Biomarkers such as glial fibrillary acidic protein (GFAP), ubiquitin C-terminal hydrolase L1 (UCH-L1), and S100 calcium-binding protein B (S100B) have shown predictive value as indicators of TBI and potential screening tools. Methods: In total, 37 controls and 118 unique trauma subjects who received a clinically ordered head computed tomography (CT) in the emergency department of a level 1 trauma center were evaluated. Blood samples collected at 0–8 hours (initial) and 12–32 hours (delayed) postinjury were analyzed for GFAP, UCH-L1, and S100B concentrations. These were then compared in CT-negative and CT-positive subjects. Results: Median GFAP, UCH-L1, and S100B concentrations were greater in CT-positive subjects at both timepoints compared with CT-negative subjects. In addition, median UCH-L1 and S100B concentrations were lower at the delayed timepoint, whereas median GFAP concentrations were increased. As predictors of a positive CT of the head, GFAP outperformed UCH-L1 and S100B at both timepoints (initial: 0.89 sensitivity, 0.62 specificity; delayed: 0.94 sensitivity, 0.67 specificity). GFAP alone also outperformed all possible combinations of biomarkers. Conclusions: GFAP, UCH-L1, and S100B demonstrated utility for rapid prediction of a CT-positive TBI within 0–8 hours of injury. GFAP exhibited the greatest predictive power at 12–32 hours. Furthermore, these results suggest that GFAP alone has greater utility for predicting a positive CT of the head than UCH-L1, S100B, or any combination of the 3.
KW - Calcium-binding protein B (S100β)
KW - Computed tomography (CT)
KW - Glial fibrillary acidic protein (GFAP)
KW - S100 ubiquitin carboxy-terminal hydrolase isozyme L1 (UCHL1)
KW - Traumatic brain injury (TBI)
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U2 - 10.1016/j.wneu.2019.04.170
DO - 10.1016/j.wneu.2019.04.170
M3 - Article
C2 - 31051301
AN - SCOPUS:85066120470
VL - 128
SP - e434-e444
JO - World Neurosurgery
JF - World Neurosurgery
SN - 1878-8750
ER -