Blood-based biomarkers for prediction of intracranial hemorrhage and outcome in patients with moderate or severe traumatic brain injury
Blood-based biomarkers for prediction of intracranial hemorrhage and outcome in patients with moderate or severe traumatic brain injury
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DOI：
10.1097/ta.0000000000002706
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发表时间：
2020-07-01
影响因子：
3.4
通讯作者：
Rowell, Susan E.
中科院分区：
文献类型：
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作者：
Anderson, Taylor N.;Hwang, Jun;Rowell, Susan E.
背景：创伤性颅内出血(ICH)的早期识别对分诊和干预有重要意义。基于血液的生物标志物最近被美国食品和药物管理局(FDA)批准用于预测轻度创伤性脑损伤(TBI)患者的脑出血。我们试图确定与格拉斯哥昏迷评分(GCS)相比，损伤后早期测量的生物标记物是否能改善中重度脑外伤(MS-TBI)患者的死亡率和临床/放射学结果的预测。方法：我们检测了到达急诊科(ED)的钝性脑损伤患者到达急诊室时胶质纤维酸性蛋白(GFAP)、泛素C末端水解酶L1(UCH-L1)和微管相关蛋白-2(MAP-2)的水平，这些患者在院前TXA的安慰剂组进行了脑外伤试验(院前GCS评分，3-12分；SPB>；90分)。生物标志物单独建模，并与院前预测变量[PH](GCS评分、年龄、性别)一起建模。将数据分为训练数据集和测试数据集，用于模型的推导和评估。对模型进行评估，以预测脑出血、肿块损害、48小时和28天的死亡率，以及6个月后格拉斯哥预后量表(GOS-E)和残疾评定量表(DRS)。结果：在243例患者中，院前GCS评分为8分(四分位数范围为5-10)，55%为脑出血，48h和28d死亡率分别为7%和13%。根据GOS-E评分小于或等于4分，6个月后有34%的患者神经功能状况不佳，而根据DRS评分大于或等于7分，则有24%的患者神经功能不良。在大多数预测模型中，将每个生物标志物添加到PH中可以改善AUC。与单纯PH相比，GFAP+PH显著改善了所有模型的AUC(脑出血，0.82vs.0.64；48小时死亡率，0.84vs.0.71；28天死亡率，0.84vs.0.66；GOS-E，0.78vs.0.69；DRS，0.84vs.0.81，均P&t；0.001)。结论：循环血液生物标志物可以改善单用院前特征的MS-TBI患者的神经预后和死亡率的预测。胶质纤维酸性蛋白似乎是最有希望的。未来在院前环境中的评估是有保证的。版权所有(C)2020 Wolters KluwerHealth，Inc.保留所有权利。
BACKGROUND: Early identification of traumatic intracranial hemorrhage (ICH) has implications for triage and intervention. Blood-based biomarkers were recently approved by the Food and Drug Administration (FDA) for prediction of ICH in patients with mild traumatic brain injury (TBI). We sought to determine if biomarkers measured early after injury improve prediction of mortality and clinical/radiologic outcomes compared with Glasgow Coma Scale (GCS) alone in patients with moderate or severe TBI (MS-TBI).METHODS: We measured glial fibrillary acidic protein (GFAP), ubiquitin C-terminal hydrolase L1 (UCH-L1), and microtubule-associated protein-2 (MAP-2) on arrival to the emergency department (ED) in patients with blunt TBI enrolled in the placebo arm of the Prehospital TXA for TBI Trial (prehospital GCS score, 3-12; SPB, > 90). Biomarkers were modeled individually and together with prehospital predictor variables [PH] (GCS score, age, sex). Data were divided into a training data set and test data set for model derivation and evaluation. Models were evaluated for prediction of ICH, mass lesion, 48-hour and 28-day mortality, and 6-month Glasgow Outcome Scale-Extended (GOS-E) and Disability Rating Scale (DRS). Area under the curve (AUC) was evaluated in test data for PH alone, PH + individual biomarkers, and PH + three biomarkers.RESULTS: Of 243 patients with baseline samples (obtained a median of 84 minutes after injury), prehospital GCS score was 8 (interquartile range, 5-10), 55% had ICH, and 48-hour and 28-day mortality were 7% and 13%, respectively. Poor neurologic outcome at 6 months was observed in 34% based on GOS-E of 4 or less, and 24% based on DRS greater than or equal to7. Addition of each biomarker to PH improved AUC in the majority of predictive models. GFAP+PH compared with PH alone significantly improved AUC in all models (ICH, 0.82 vs. 0.64; 48-hour mortality, 0.84 vs. 0.71; 28-day mortality, 0.84 vs. 0.66; GOS-E, 0.78 vs. 0.69; DRS, 0.84 vs. 0.81, all p < 0.001).CONCLUSION: Circulating blood-based biomarkers may improve prediction of neurological outcomes and mortality in patients with MS-TBI over prehospital characteristics alone. Glial fibrillary acidic protein appears to be the most promising. Future evaluation in the prehospital setting is warranted. Copyright (c) 2020 Wolters Kluwer Health, Inc. All rights reserved.