Blood biomarkers on admission in acute traumatic brain injury: Relations to severity, CT findings and care path in the CENTER-TBI study

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Blood biomarkers on admission in acute traumatic brain injury : Relations to severity, CT findings and care path in the CENTER-TBI study

Czeiter, Endre (författare): Department of Neurosurgery, Medical School, University of Pécs, Pécs, Hungary; Neurotrauma Research Group, Szentágothai Research Centre, University of Pécs, Hungary; MTA-PTE Clinical Neuroscience MR Research Group, Pécs, Hungary

Amrein, Krisztina (författare): Department of Neurosurgery, Medical School, University of Pécs, Pécs, Hungary; Neurotrauma Research Group, Szentágothai Research Centre, University of Pécs, Hungary

Gravesteijn, Benjamin Y. (författare): Center for Medical Decision Making, Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands

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Lecky, Fiona (författare): Centre for Urgent and emergency care REsearch (CURE), Health Services Research Section, School of Health and Related Research (ScHARR), University of Sheffield, UK; Emergency Department, Salford Royal Hospital, Stott Ln, Salford, UK

Menon, David K. (författare): Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, UK

Mondello, Stefania (författare): Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy

Newcombe, Virginia F. J. (författare): Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, UK

Richter, Sophie (författare): Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, UK

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

Vyvere, Thijs Vande (författare): Research and Development, Icometrix, Leuven, Belgium; Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium

Verheyden, Jan (författare): Research and Development, Icometrix, Leuven, Belgium

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

Maas, Andrew I. R. (författare): Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium

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 (VAMC), Gainesville, FL, USA

Büki, Andras, 1966- (författare): Department of Neurosurgery, Medical School, University of Pécs, Pécs, Hungary; Neurotrauma Research Group, Szentágothai Research Centre, University of Pécs, Hungary

Brorsson, Camilla (bidragsgivare): Umeå universitet,Institutionen för kirurgisk och perioperativ vetenskap

Koskinen, Lars-Owe, Professor, 1955- (bidragsgivare): Umeå universitet,Neurovetenskaper

Sundström, Nina (bidragsgivare): Umeå universitet,Institutionen för strålningsvetenskaper

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Elsevier, 2020
2020
Engelska.
Ingår i: EBioMedicine. - : Elsevier. - 2352-3964. ; 56

Relaterad länk:: https://doi.org/10.1...; visa fler...; http://www.thelancet...; https://umu.diva-por... (primary) (Raw object); https://urn.kb.se/re...; https://doi.org/10.1...; https://urn.kb.se/re...; http://kipublication...; visa färre...

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BACKGROUND: Serum biomarkers may inform and improve care in traumatic brain injury (TBI). We aimed to correlate serum biomarkers with clinical severity, care path and imaging abnormalities in TBI, and explore their incremental value over clinical characteristics in predicting computed tomographic (CT) abnormalities.METHODS: We analyzed six serum biomarkers (S100B, NSE, GFAP, UCH-L1, NFL and t-tau) obtained <24 h post-injury from 2867 patients with any severity of TBI in the Collaborative European NeuroTrauma Effectiveness Research (CENTER-TBI) Core Study, a prospective, multicenter, cohort study. Univariable and multivariable logistic regression analyses were performed. Discrimination was assessed by the area under the receiver operating characteristic curve (AUC) with 95% confidence intervals.FINDINGS: All biomarkers scaled with clinical severity and care path (ER only, ward admission, or ICU), and with presence of CT abnormalities. GFAP achieved the highest discrimination for predicting CT abnormalities (AUC 0•89 [95%CI: 0•87-0•90]), with a 99% likelihood of better discriminating CT-positive patients than clinical characteristics used in contemporary decision rules. In patients with mild TBI, GFAP also showed incremental diagnostic value: discrimination increased from 0•84 [95%CI: 0•83-0•86] to 0•89 [95%CI: 0•87-0•90] when GFAP was included. Results were consistent across strata, and injury severity. Combinations of biomarkers did not improve discrimination compared to GFAP alone.INTERPRETATION: Currently available biomarkers reflect injury severity, and serum GFAP, measured within 24 h after injury, outperforms clinical characteristics in predicting CT abnormalities. Our results support the further development of serum GFAP assays towards implementation in clinical practice, for which robust clinical assay platforms are required.FUNDING: CENTER-TBI study was supported by the European Union 7th Framework program (EC grant 602150).

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Blood biomarkers on admission in acute traumatic brain injury : Relations to severity, CT findings and care path in the CENTER-TBI study

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