Relationship between peripheral blood biomarkers and head CT after traumatic brain injury

Recent studies have found several new protein biomarkers with high brain specificity that may help predict the need for post-TBI CT testingGlial fibrillary acidic protein (GFAP) is expressed in the cytoskeleton of glial cells and has been detected in the blood during acute TBI- Excerpted from the article chapter: Posti JP, et alJ Neurotrauma2019 Apr 5doi: 10.1089/neu.2018.6254Theit is difficult to determine when a head CT scan will be performed on a patient with traumatic brain injury (
TBI) due to a number of factorsIn TBI patients who performed CT scans according to current head CT screening guidelines, a large proportion of negative results occurredThe effect of testing for biomarkers in the blood after TBI on the judgment of intracranial trauma is not clearThe Scandinavian Guidelines for the Treatment of Mild Brain Injury (mTBI) recommend the detection of S100 calcium binding protein B (S100 calcium-binding protein B, S100B) within 6h of hospitalization for patients with mild traumatic brain injury (mTBI), which can be used to analyze the correlation between S100B levels and head CT test resultsHowever, S100B is expressed in a variety of extra-brain tissues, and its level increases during extracranial injury or after physical exerciserecent research has found several new protein biomarkers with high brain specificity that may help predict the need for post-TBI CT testingGlial fibrillary acidic protein (GFAP) is expressed in the cytoskeleton of glial cells and has been detected in the blood during acute TBI The combination of S100B, GFAP and ubiquitin-based hydrolysis L1 (ubiquitin C-terminal hydrolase L1, UCH-L1) may have an application prospect of evaluating ct-negative or positive results in acute TBI patients , heart fatty acid binding protein (H-FABP) is a cytoplasmic transport erthal protein that is expressed in the heart and also in the brain, and has been shown to predict tBI-related intracranial pathological changes; Other brain-related protein biomarkers, including beta-amyloid subtype 1-40 (beta-amyloid isoforms 1-40, Beta 40) and beta-amyloid iform 1-42 (beta-amyloid iforms 1-42, A beta 42), reflecting amyloid The metabolism of protein precursors; neurofilament light chain (NF-L) is rich in axons with longer myelin under the cortex, microtube-related protein tau proteins are located in the axon cytoskeleton, and the study of the above 4 proteins has been carried out in patients with subacute and chronic TBI, but the effect of ct examination in patients with acute TBI is not clear can be seen, due to the complexity of the brain and The heterogeneity of TBI, it is more important to find an optimized combination of biomarkers for different clinical conditions than to find a single biomarker Jussi P Posti et al used highly sensitive immunoassays to detect eight protein biomarkers in TBI patients, namely Abeta 40, A beta 42, GFAP, H-FABP, IL-10, NF-L, S100B and tau proteins, and their combinations, in a predicted negative or positive effect of head CT scans, published online in April 2019 in Journal of The Journal the study included 160 TBI patients treated at Turku University Hospital between November 2011 and October 2013 (Table 1) All patients took blood samples at 24h of admission to detect levels of A beta 40 and A beta 42, GFAP, H-FAB, IL-10, NF-L, S100B and tau proteins According to the CT test results, 65 patients were divided into CT-negative group and 95 patients were CT-positive, and all patients with different severity of GCS scores of 3-15 were analyzed and mTBI patients with GCS scores of 13-15 were analyzed Table 1 Demographic data for different TBI subgroups results showed that NF-L, GFAP, and tau proteins had the best effect in predicting CT negative or positive in mTBI patients and all patients with different severity of TBI In patients with different severity TBI, the area (AUC) under the working characteristic curve of the subjects of GFAP, NF-L and tau protein was 0.822, 0.817 and 0.781, respectively In mTBI patients, the AUC of GFAP, tau protein and NF-L was 0.720, 0.689 and 0.676, respectively the best combination of 3 biomarkers used to predict CT-negative or CT-positive patients in different severity TBI groups was GFAP-H-FABP-IL-10, with a sensitivity of 100% and a specificity of 38.5% In the mTBI group, the best combination of the three biomarkers was the H-FABP-S100B-tau protein, which had a sensitivity of 100% and a specificity of 46.4% finally, the results showed that the peripheral blood protein biomarker combination was better than a single biomarker in patients with CT-negative and CT-positive TBI In the different severity TBI groups, the combination of GFAP-H-FABP-IL-10 was the best in predicting the specificity and sensitivity of CT-positive and CT-negative patients In the mTBI group, the specificity and sensitivity of the H-FABP-S100B-tau protein were the best Therefore, different biomarker combinations may be required to find the best diagnostic tool for different types of patients The authors point out that the predictive effects of biomarker combinations and the guiding value of existing head CT examination guidelines must be coordinated and harmonized in further research.