Glial Fibrillary Acidic Protein and Ubiquitin C-Terminal Hydrolase-L1 as Outcome Predictors in Traumatic Brain Injury

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• 作者：Riikka S.K. Takala¹ ; ^{riikka.takala@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Jussi P. Posti² ; ³ ; ⁴ ; Hilkka Runtti⁵ ; Virginia F. Newcombe⁶ ; Joanne Outtrim⁶ ; Ari J. Katila¹ ; Janek Frantzé ; n² ; ³ ; Henna Ala-Seppä ; lä ; ⁴ ; Anna Kyllö ; nen⁴ ; Henna-Riikka Maanpä ; ä ; ⁴ ; Jussi Tallus⁴ ; Md. Iftakher Hossain⁴ ; Jonathan P. Coles⁶ ; Peter Hutchinson⁷ ; Mark van Gils⁵ ; David K. Menon⁶ ; Olli Tenovuo³ ; ⁴
• 关键词：Biomarkers ; GFAP ; Outcome ; Traumatic brain injury ; UCH-L1
• 刊名：World Neurosurgery
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：87
• 期：Complete
• 页码：8-20
• 全文大小：15541 K

文摘

Biomarkers ubiquitin C-terminal hydrolase-L1 (UCH-L1) and glial fibrillary acidic protein (GFAP) may help detect brain injury, assess its severity, and improve outcome prediction. This study aimed to evaluate the prognostic value of these biomarkers during the first days after brain injury.

d="absSec_2">Methods

d="abspara0015">Serum UCH-L1 and GFAP were measured in 324 patients with traumatic brain injury (TBI) enrolled in a prospective study. The outcome was assessed using the Glasgow Outcome Scale (GOS) or the extended version, Glasgow Outcome Scale–Extended (GOSE).

d="absSec_3">Results

d="abspara0020">Patients with full recovery had lower UCH-L1 concentrations on the second day and patients with favorable outcome had lower UCH-L1 concentrations during the first 2 days compared with patients with incomplete recovery and unfavorable outcome. Patients with full recovery and favorable outcome had significantly lower GFAP concentrations in the first 2 days than patients with incomplete recovery or unfavorable outcome. There was a strong negative correlation between outcome and UCH-L1 in the first 3 days and GFAP levels in the first 2 days. On arrival, both UCH-L1 and GFAP distinguished patients with GOS score 1–3 from patients with GOS score 4–5, but not patients with GOSE score 8 from patients with GOSE score 1–7. For UCH-L1 and GFAP to predict unfavorable outcome (GOS score ≤3), the area under the receiver operating characteristic curve was 0.727, and 0.723, respectively. Neither UCHL-1 nor GFAP was independently able to predict the outcome when age, worst Glasgow Coma Scale score, pupil reactivity, Injury Severity Score, and Marshall score were added into the multivariate logistic regression model.

d="absSec_4">Conclusions

d="abspara0025">GFAP and UCH-L1 are significantly associated with outcome, but they do not add predictive power to commonly used prognostic variables in a population of patients with TBI of varying severities.