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Incremental prognostic value of acute serum biomarkers for functional outcome after traumatic brain injury (CENTER-TBI) : an observational cohort study

Helmrich, Isabel R. A. Retel (författare)
Center for Medical Decision Making, Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
Czeiter, Endre (författare)
Department of Neurosurgery, Medical School, and Neurotrauma Research Group, Szentágothai Research Centre, University of Pécs, Pécs, Hungary; MTA-PTE Clinical Neuroscience MR Research Group, Pécs, Hungary
Amrein, Krisztina (författare)
Department of Neurosurgery, Medical School, and Neurotrauma Research Group, Szentágothai Research Centre, University of Pécs, Pécs, Hungary; MTA-PTE Clinical Neuroscience MR Research Group, Pécs, Hungary
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Büki, Andras, 1966- (författare)
Örebro universitet,Institutionen för medicinska vetenskaper,Department of Neurosurgery, Medical School, and Neurotrauma Research Group, Szentágothai Research Centre, University of Pécs, Pécs, Hungary; Department of Neurosurgery Faculty of Medicine and Health Örebro University, Örebro, Sweden
Lingsma, Hester F (författare)
Center for Medical Decision Making, Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
Menon, David K. (författare)
Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
Mondello, Stefania (författare)
Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
Steyerberg, Ewout W. (författare)
Center for Medical Decision Making, Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands; Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
von Steinbüchel, Nicole (författare)
Institute of Medical Psychology and Medical Sociology, Universitätsmedizin Göttingen, Göttingen, Germany
Wang, Kevin K. W. (författare)
Program for Neurotrauma, Neuroproteomics and Biomarker Research, Departments of Emergency Medicine, Psychiatry and Neuroscience, University of Florida, McKnight Brain Institute, Gainesville, FL, USA; Brain Rehabilitation Research Center, Malcom Randall Veterans Affairs Medical Center, Gainesville, FL, USA
Wilson, Lindsay (författare)
Division of Psychology, University of Stirling, Stirling, UK
Xu, Haiyan (författare)
Program for Neurotrauma, Neuroproteomics and Biomarker Research, Departments of Emergency Medicine, Psychiatry and Neuroscience, University of Florida, McKnight Brain Institute, Gainesville, FL, USA
Yang, Zhihui (författare)
Program for Neurotrauma, Neuroproteomics and Biomarker Research, Departments of Emergency Medicine, Psychiatry and Neuroscience, University of Florida, McKnight Brain Institute, Gainesville, FL, USA
van Klaveren, David (författare)
Predictive Analytics and Comparative Effectiveness Center, Institute for Clinical Research and Health Policy Studies/Tufts Medical Center, Boston, MA, USA
Maas, Andrew I. R. (författare)
Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
CENTER-TBI participants and investigators, - (bidragsgivare)
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 (creator_code:org_t)
The Lancet Publishing Group, 2022
2022
Engelska.
Ingår i: Lancet Neurology. - : The Lancet Publishing Group. - 1474-4422 .- 1474-4465. ; 21:9, s. 792-802
Relaterad länk:
https://urn.kb.se/re...
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https://doi.org/10.1...
http://kipublication...
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  • Tidskriftsartikel (refereegranskat)
Abstract Ämnesord
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  • BACKGROUND: Several studies have reported an association between serum biomarker values and functional outcome following traumatic brain injury. We aimed to examine the incremental (added) prognostic value of serum biomarkers over demographic, clinical, and radiological characteristics and over established prognostic models, such as IMPACT and CRASH, for prediction of functional outcome.METHODS: We used data from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) core study. We included patients aged 14 years or older who had blood sampling within 24 h of injury, results from a CT scan, and outcome assessment according to the Glasgow Outcome Scale-Extended (GOSE) at 6 months. Amounts in serum of six biomarkers (S100 calcium-binding protein B, neuron-specific enolase, glial fibrillary acidic protein, ubiquitin C-terminal hydrolase L1 [UCH-L1], neurofilament protein-light, and total tau) were measured. The incremental prognostic value of these biomarkers was determined separately and in combination. The primary outcome was the GOSE 6 months after injury. Incremental prognostic value, using proportional odds and a dichotomised analysis, was assessed by delta C-statistic and delta R2 between models with and without serum biomarkers, corrected for optimism with a bootstrapping procedure.FINDINGS: Serum biomarker values and 6-month GOSE were available for 2283 of 4509 patients. Higher biomarker levels were associated with worse outcome. Adding biomarkers improved the C-statistic by 0·014 (95% CI 0·009-0·020) and R2 by 4·9% (3·6-6·5) for predicting GOSE compared with demographic, clinical, and radiological characteristics. UCH-L1 had the greatest incremental prognostic value. Adding biomarkers to established prognostic models resulted in a relative increase in R2 of 48-65% for IMPACT and 30-34% for CRASH prognostic models.INTERPRETATION: Serum biomarkers have incremental prognostic value for functional outcome after traumatic brain injury. Our findings support integration of biomarkers-particularly UCH-L1-in established prognostic models.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Neurologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Neurology (hsv//eng)

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