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  • Richter, SophieUniversity Division of Anaesthesia, University of Cambridge, Box 93, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK (författare)

Serum biomarkers identify critically ill traumatic brain injury patients for MRI

  • Artikel/kapitelEngelska2022

Förlag, utgivningsår, omfång ...

  • 2022-11-29
  • BioMed Central (BMC),2022
  • printrdacarrier

Nummerbeteckningar

  • LIBRIS-ID:oai:DiVA.org:oru-102533
  • https://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-102533URI
  • https://doi.org/10.1186/s13054-022-04250-3DOI
  • https://lup.lub.lu.se/record/1fde7302-50ba-40b1-9acd-90eb1b2ed5faURI

Kompletterande språkuppgifter

  • Språk:engelska
  • Sammanfattning på:engelska

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Klassifikation

  • Ämneskategori:ref swepub-contenttype
  • Ämneskategori:art swepub-publicationtype

Anmärkningar

  • Funding agencies:Hannelore Kohl Stiftung (Germany)OneMind (USA)Integra LifeSciences Corporation (USA)NeuroTrauma Sciences (USA)National Institute for Health Research (NIHR)Academy of Medical Sciences/The Health Foundation (UK) 
  • BACKGROUND: Magnetic resonance imaging (MRI) carries prognostic importance after traumatic brain injury (TBI), especially when computed tomography (CT) fails to fully explain the level of unconsciousness. However, in critically ill patients, the risk of deterioration during transfer needs to be balanced against the benefit of detecting prognostically relevant information on MRI. We therefore aimed to assess if day of injury serum protein biomarkers could identify critically ill TBI patients in whom the risks of transfer are compensated by the likelihood of detecting management-altering neuroimaging findings.METHODS: Data were obtained from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. Eligibility criteria included: TBI patients aged ≥ 16 years, Glasgow Coma Score (GCS) < 13 or patient intubated with unrecorded pre-intubation GCS, CT with Marshall score < 3, serum biomarkers (GFAP, NFL, NSE, S100B, Tau, UCH-L1) sampled ≤ 24 h of injury, MRI < 30 days of injury. The degree of axonal injury on MRI was graded using the Adams-Gentry classification. The association between serum concentrations of biomarkers and Adams-Gentry stage was assessed and the optimum threshold concentration identified, assuming different minimum sensitivities for the detection of brainstem injury (Adams-Gentry stage 3). A cost-benefit analysis for the USA and UK health care settings was also performed. RESULTS: Among 65 included patients (30 moderate-severe, 35 unrecorded) axonal injury was detected in 54 (83%) and brainstem involvement in 33 (51%). In patients with moderate-severe TBI, brainstem injury was associated with higher concentrations of NSE, Tau, UCH-L1 and GFAP. If the clinician did not want to miss any brainstem injury, NSE could have avoided MRI transfers in up to 20% of patients. If a 94% sensitivity was accepted considering potential transfer-related complications, GFAP could have avoided 30% of transfers. There was no added net cost, with savings up to £99 (UK) or $612 (US). No associations between proteins and axonal injury were found in intubated patients without a recorded pre-intubation GCS.CONCLUSIONS: Serum protein biomarkers show potential to safely reduce the number of transfers to MRI in critically ill patients with moderate-severe TBI at no added cost.

Ämnesord och genrebeteckningar

Biuppslag (personer, institutioner, konferenser, titlar ...)

  • Winzeck, StefanUniversity Division of Anaesthesia, University of Cambridge, Box 93, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK; Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, UK (författare)
  • Czeiter, EndreDepartment of Neurosurgery, Medical School, University of Pécs, Pecs, Hungary; Neurotrauma Research Group, Szentágothai Research Centre, University of Pécs, Pecs, Hungary; ELKH-PTE Clinical Neuroscience MR Research Group, University of Pécs, Pecs, Hungary (författare)
  • Amrein, KrisztinaDepartment of Neurosurgery, Medical School, University of Pécs, Pecs, Hungary; Neurotrauma Research Group, Szentágothai Research Centre, University of Pécs, Pecs, Hungary; ELKH-PTE Clinical Neuroscience MR Research Group, University of Pécs, Pecs, Hungary (författare)
  • Kornaropoulos, Evgenios N.Lund University,Lunds universitet,Diagnostisk radiologi, Lund,Sektion V,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Diagnostic Radiology, (Lund),Section V,Department of Clinical Sciences, Lund,Faculty of Medicine(Swepub:lu)ev2115ko (författare)
  • Verheyden, JanResearch and Development, icometrix, Leuven, Belgium (författare)
  • Sugar, GabrielaBrain and Spinal Injury Center, University of California, San Francisco, San Francisco, CA, USA (författare)
  • Yang, ZhihuiProgram for Neurotrauma, Neuroproteomics and Biomarker Research, Departments of Emergency Medicine, Psychiatry and Neuroscience, University of Florida, Gainesville, USA (författare)
  • Wang, KevinProgram for Neurotrauma, Neuroproteomics and Biomarker Research, Departments of Emergency Medicine, Psychiatry and Neuroscience, University of Florida, Gainesville, USA (författare)
  • Maas, Andrew I. R.Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium (författare)
  • Steyerberg, EwoutDepartment of Biomedical Data Sciences, University Medical Centre, Leiden, Netherlands (författare)
  • Büki, Andras,1966-Örebro University,Örebro universitet,Institutionen för medicinska vetenskaper,Department of Neurosurgery, Medical School, University of Pécs, Pecs, Hungary; Neurotrauma Research Group, Szentágothai Research Centre, University of Pécs, Pecs, Hungary; Department of Neurosurgery, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden(Swepub:oru)asbi (författare)
  • Newcombe, Virginia F JUniversity Division of Anaesthesia, University of Cambridge, Box 93, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK (författare)
  • Menon, David K.University Division of Anaesthesia, University of Cambridge, Box 93, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK (författare)
  • Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury Magnetic Resonance Imaging (CENTER-TBI MRI) Sub-study Participants and Investigators, - (bidragsgivare)
  • University Division of Anaesthesia, University of Cambridge, Box 93, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UKUniversity Division of Anaesthesia, University of Cambridge, Box 93, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK; Biomedical Image Analysis Group, Department of Computing, Imperial College London, London, UK (creator_code:org_t)

Sammanhörande titlar

  • Ingår i:Critical Care: BioMed Central (BMC)26:11364-85351466-609X

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