8 research outputs found
Biomarkers Improve Clinical Outcome Predictors of Mortality Following Non-Penetrating Severe Traumatic Brain Injury
This study assessed whether early levels of biomarkers measured in CSF within 24-h of severe TBI would improve the clinical prediction of 6-months mortality.
This prospective study conducted at two Level 1 Trauma Centers enrolled adults with severe TBI (GCS a parts per thousand currency sign8) requiring a ventriculostomy as well as control subjects. Ventricular CSF was sampled within 24-h of injury and analyzed for seven candidate biomarkers (UCH-L1, MAP-2, SBDP150, SBDP145, SBDP120, MBP, and S100B). The International Mission on Prognosis and Analysis of Clinical Trials in TBI (IMPACT) scores (Core, Extended, and Lab) were calculated for each patient to determine risk of 6-months mortality. The IMPACT models and biomarkers were assessed alone and in combination.
There were 152 patients enrolled, 131 TBI patients and 21 control patients. Thirty six (27 %) patients did not survive to 6 months. Biomarkers were all significantly elevated in TBI versus controls (p < 0.001). Peak levels of UCH-L1, SBDP145, MAP-2, and MBP were significantly higher in non-survivors (p < 0.05). Of the seven biomarkers measured at 12-h post-injury MAP-2 (p = 0.004), UCH-L1 (p = 0.024), and MBP (p = 0.037) had significant unadjusted hazard ratios. Of the seven biomarkers measured at the earliest time within 24-h, MAP-2 (p = 0.002), UCH-L1 (p = 0.016), MBP (p = 0.021), and SBDP145 (0.029) had the most significant elevations. When the IMPACT Extended Model was combined with the biomarkers, MAP-2 contributed most significantly to the survival models with sensitivities of 97-100 %.
These data suggest that early levels of MAP-2 in combination with clinical data provide enhanced prognostic capabilities for mortality at 6 months
Update on protein biomarkers in traumatic brain injury with emphasis on clinical use in adults and pediatrics
Purpose This review summarizes protein biomarkers in
mild and severe traumatic brain injury in adults and
children and presents a strategy for conducting rationally
designed clinical studies on biomarkers in head trauma.
Methods We performed an electronic search of the National
Library of Medicine’s MEDLINE and Biomedical Library
of University of Pennsylvania database in March 2008
using a search heading of traumatic head injury and protein
biomarkers. The search was focused especially on protein
degradation products (spectrin breakdown product, c-tau,
amyloid-β1–42) in the last 10 years, but recent data on
“classical” markers (S-100B, neuron-specific enolase, etc.)
were also examined.
Results We identified 85 articles focusing on clinical use of
biomarkers; 58 articles were prospective cohort studies with
injury and/or outcome assessment.
Conclusions We conclude that only S-100B in severe
traumatic brain injury has consistently demonstrated the
ability to predict injury and outcome in adults. The number
of studies with protein degradation products is insufficient
especially in the pediatric care. Cohort studies with welldefined
end points and further neuroproteomic search for
biomarkers in mild injury should be triggered. After
critically reviewing the study designs, we found that large
homogenous patient populations, consistent injury, and
outcome measures prospectively determined cutoff values,
and a combined use of different predictors should be
considered in future studies