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Prognostic Value of Serum Biomarkers in Patients With Moderate-Severe Traumatic Brain Injury, Differentiated by Marshall Computer Tomography Classification
Cambridge University, 2152, Division of Anaesthesia, Cambridge, Cambridgeshire, United Kingdom of Great Britain and Northern Ireland.
University of Pecs Medical School, 37657, Department of Neurosurgery, Szentágothai Research Centre and ELKH-PTE Clinical Neuroscience MR Research Group, Pecs, Hungary.
University of Pecs Medical School, 37657, Department of Neurosurgery, Szentágothai Research Centre and ELKH-PTE Clinical Neuroscience MR Research Group, Pecs, Hungary.
The University of British Columbia, 8166, Department of Psychology, Vancouver, British Columbia, Canada; GF Strong Rehabilitation Centre, Rehabilitation Research Program, Vancouver, Canada.
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2023 (English)In: Journal of Neurotrauma, ISSN 0897-7151, E-ISSN 1557-9042, Vol. 40, no 21-22, p. 2297-2310Article in journal (Refereed) Published
Abstract [en]

Prognostication is challenging in patients with traumatic brain injury (TBI) in whom computed tomography (CT) fails to fully explain a low level of consciousness. Serum biomarkers reflect the extent of structural damage in a different way than CT does, but it is unclear whether biomarkers provide additional prognostic value across the range of CT abnormalities. This study aimed to determine the added predictive value of biomarkers, differentiated by imaging severity. This prognostic study used data from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study (2014-2017). The analysis included patients aged & GE;16 years with a moderate-severe TBI (Glasgow Coma Scale [GCS] <13) who had an acute CT and serum biomarkers obtained & LE;24h of injury. Of six protein biomarkers (GFAP, NFL, NSE, S100B, Tau, UCH-L1), the most prognostic panel was selected using lasso regression. The performance of established prognostic models (CRASH and IMPACT) was assessed before and after the addition of the biomarker panel and compared between patients with different CT Marshall scores (Marshall score <3 vs. Marshall score & GE;3). Outcome was assessed at six months post-injury using the extended Glasgow Outcome Scale (GOSE), and dichotomized into favorable and unfavorable (GOSE <5). We included 872 patients with moderate-severe TBI. The mean age was 47 years (range 16-95); 647 (74%) were male and 438 (50%) had a Marshall CT score <3. The serum biomarkers GFAP, NFL, S100B and UCH-L1 provided complementary prognostic information; NSE and Tau showed no added value. The addition of the biomarker panel to established prognostic models increased the area under the curve (AUC) by 0.08 and 0.03, and the explained variation in outcome by 13-14% and 7-8%, for patients with a Marshall score of <3 and & GE;3, respectively. The incremental AUC of biomarkers for individual models was significantly greater when the Marshall score was <3 compared with & GE;3 (p < 0.001). Serum biomarkers improve outcome prediction after moderate-severe TBI across the range of imaging severities and especially in patients with a Marshall score <3.

Place, publisher, year, edition, pages
Mary Ann Liebert, 2023. Vol. 40, no 21-22, p. 2297-2310
Keywords [en]
adult brain injury, biomarkers, CT scanning, prospective study, traumatic brain, injury
National Category
Neurosciences
Identifiers
URN: urn:nbn:se:oru:diva-106671DOI: 10.1089/neu.2023.0029ISI: 001048918300001PubMedID: 37376742Scopus ID: 2-s2.0-85170700661OAI: oai:DiVA.org:oru-106671DiVA, id: diva2:1777150
Available from: 2023-06-29 Created: 2023-06-29 Last updated: 2024-09-04Bibliographically approved

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