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This article is from the NEJM Journal Watch Prognostic Value of Biomarkers in Traumatic Brain Injury Biomarkers for the Prognostic
Significance of Head Injury
Reviewed by Jaime Toro, MD
GFAP and UCH-L1 are predictors
of functional recovery in patients with head injury (TBI).
TBI is an important cause of death, and even mild brain trauma can lead to disability
.
Patient outcomes are influenced by pre-injury factors, such as patient characteristics and injury characteristics, and quality of
care.
Prognostic models and predictors help clinicians provide reliable information
to patients and their families.
Over the past 10 years, scientists have developed several blood biomarkers of glial and neuronal cell damage that can be used to determine prognosis
if measured on the day of injury 。 The investigators conducted two observational cohort analyses, namely the CENTER-TBI (Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury) core study and the Track TBI (U.
S.
Translational Research and Clinical Knowledge of Head Injury, U.
S.
Transforming Research and Clinical Knowledge in Traumatic Brain Injury) to determine the prognostic significance
of serum biomarkers for functional outcomes following head injury.
The CENTER-TBI study measured six serum biomarkers: S100 calcibin B, neuron-specific enolase, glial fibril acidic protein, ubiquitin carboxyl-terminal hydrolase L1 [UCH-L1], neurofilament protein light chain, and total tau protein
。 Of the 4,509 patients, the researchers obtained serum biomarker values and Glasgow Outcome Scale-Expanded (GOSE) scores
at 6 months for 2,283 patients.
Higher biomarker levels are associated with poor prognosis; The combination of multiple biomarkers can improve prognostic significance
.
The combined application of GFAP and UCH-L1 failed to improve the discriminative ability
compared with UCH-L1 alone.
UCH-L1 and t-tau are the most
predictors of death.
In the Track TBI study, 2,552 patients were included in the study and 1,696 patients were included in the analysis
.
Plasma samples from the day of injury were collected for GFAP and UCH-L1 measurement, and the patient was evaluated
for GOSE-TBI at 6 months.
GFAP and UCH-L1 plasma concentrations are highly prognostic for death and adverse outcomes, but not for incomplete recovery at six months
.
In this study, biomarkers provided the most prognostic information
for patients with GCS scores of 3~12 points.
Commenting on biomarkers is very helpful for clinicians in predicting functional recovery after head injury
.
The combination of multiple biomarkers can improve prognostic significance
.
However, for prognosis and death prediction, UCH-L1 alone appears to have the greatest utility
.
GFAP and UCH-L1 have been approved by the U.
S.
FDA as diagnostic tests for head injury
.
Although the CENTER-TBI study suggests that combining multiple biomarkers to predict functional outcomes in patients with TBI can achieve higher performance, clinical practice may favor the use of one marker in low- and middle-income countries
.
Articles that are commented on
Related reading
.
NEJM Medical Frontiers is translated several times a week, published on the app and official website, and selected 2-3 articles are published
on WeChat.
Copyright Information This article is translated, written or commissioned
by Jiahui Medical Research and Education Group (J-Med) and the New England Journal of Medicine (NEJM).
The full Chinese translation and the figures contained therein are exclusively licensed
by NEJM Group.
If you need to reprint, please leave a message or contact nejmqianyan@nejmqianyan.
cn
.
Unauthorized translation is an infringement and the copyright owner reserves the right to
pursue legal responsibility.
Significance of Head Injury
Reviewed by Jaime Toro, MD
GFAP and UCH-L1 are predictors
of functional recovery in patients with head injury (TBI).
TBI is an important cause of death, and even mild brain trauma can lead to disability
.
Patient outcomes are influenced by pre-injury factors, such as patient characteristics and injury characteristics, and quality of
care.
Prognostic models and predictors help clinicians provide reliable information
to patients and their families.
Over the past 10 years, scientists have developed several blood biomarkers of glial and neuronal cell damage that can be used to determine prognosis
if measured on the day of injury 。 The investigators conducted two observational cohort analyses, namely the CENTER-TBI (Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury) core study and the Track TBI (U.
S.
Translational Research and Clinical Knowledge of Head Injury, U.
S.
Transforming Research and Clinical Knowledge in Traumatic Brain Injury) to determine the prognostic significance
of serum biomarkers for functional outcomes following head injury.
The CENTER-TBI study measured six serum biomarkers: S100 calcibin B, neuron-specific enolase, glial fibril acidic protein, ubiquitin carboxyl-terminal hydrolase L1 [UCH-L1], neurofilament protein light chain, and total tau protein
。 Of the 4,509 patients, the researchers obtained serum biomarker values and Glasgow Outcome Scale-Expanded (GOSE) scores
at 6 months for 2,283 patients.
Higher biomarker levels are associated with poor prognosis; The combination of multiple biomarkers can improve prognostic significance
.
The combined application of GFAP and UCH-L1 failed to improve the discriminative ability
compared with UCH-L1 alone.
UCH-L1 and t-tau are the most
predictors of death.
In the Track TBI study, 2,552 patients were included in the study and 1,696 patients were included in the analysis
.
Plasma samples from the day of injury were collected for GFAP and UCH-L1 measurement, and the patient was evaluated
for GOSE-TBI at 6 months.
GFAP and UCH-L1 plasma concentrations are highly prognostic for death and adverse outcomes, but not for incomplete recovery at six months
.
In this study, biomarkers provided the most prognostic information
for patients with GCS scores of 3~12 points.
Commenting on biomarkers is very helpful for clinicians in predicting functional recovery after head injury
.
The combination of multiple biomarkers can improve prognostic significance
.
However, for prognosis and death prediction, UCH-L1 alone appears to have the greatest utility
.
GFAP and UCH-L1 have been approved by the U.
S.
FDA as diagnostic tests for head injury
.
Although the CENTER-TBI study suggests that combining multiple biomarkers to predict functional outcomes in patients with TBI can achieve higher performance, clinical practice may favor the use of one marker in low- and middle-income countries
.
Articles that are commented on
[1] Helmrich IRAR et al.
Incremental prognostic value of acute serum biomarkers for functional outcome after traumatic brain injury (CENTER-TBI): An observational cohort study.
Lancet Neurol 2022 Sep; 21:792.
(https://doi.
org/10.
1016/S1474-4422(22)00218-6)
[2] Korley FK et al.
Prognostic value of day-of-injury plasma GFAP and UCH-L1 concentrations for predicting functional recovery after traumatic brain injury in patients from the US TRACK-TBI cohort: An observational cohort study.
Lancet Neurol 2022 Sep; 21:803.
(https://doi.
org/10.
1016/S1474-4422(22)00256-3)
Related reading
NEJM Journal Collection
Published by NEJM Group, NEJM Journal Watch invites internationally renowned doctors to review important papers in the medical field to help doctors understand and apply the latest developments.
NEJM Medical Frontiers is translated several times a week, published on the app and official website, and selected 2-3 articles are published
on WeChat.
Copyright Information This article is translated, written or commissioned
by Jiahui Medical Research and Education Group (J-Med) and the New England Journal of Medicine (NEJM).
The full Chinese translation and the figures contained therein are exclusively licensed
by NEJM Group.
If you need to reprint, please leave a message or contact nejmqianyan@nejmqianyan.
cn
.
Unauthorized translation is an infringement and the copyright owner reserves the right to
pursue legal responsibility.
