Effects of age and time since injury on traumatic brain injury blood biomarkers: a TRACK-TBI study.
Effects of age and time since injury on traumatic brain injury blood biomarkers: a TRACK-TBI study.
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DOI：
10.1093/braincomms/fcac316
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发表时间：
2023
影响因子：
4.8
通讯作者：
中科院分区：
文献类型：
--
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老年人是全球创伤性脑损伤发病率最高的人群。需要准确的血液生物标志物来帮助诊断不同年龄和受伤后时间的患者。一些报告表明，老年人血液生物标志物的准确性较低，并且在受伤后第1天之后的数据很少。我们的目的是调查年龄相关的诊断准确性差异和2周演变的四个领先的候选血液为基础的创伤性脑损伤生物标志物-血浆胶质细胞酸性蛋白，泛素羧基末端水解酶L1，S100钙结合蛋白B和神经元特异性烯醇化酶之间的参与者在18个地点的前瞻性队列研究转化研究和临床知识的创伤性脑损伤。第1天的生物标志物数据可用于2602名参与者，包括2151名创伤性脑损伤患者，242名骨科创伤对照和209名健康对照。参与者分为3个年龄组（年轻：17-39岁，中年：40-64岁，老年：65-90岁）。我们研究了三个诊断组的年龄分层生物标志物水平和生物标志物区分能力：头部CT阳性/阴性;创伤性脑损伤/骨科对照;和创伤性脑损伤/健康对照。第1天胶质细胞酸性蛋白，泛素羧基末端水解酶L1和神经元特异性烯醇化酶水平的差异在大多数诊断组中，老年人与年轻人相比显着较小，导致在较窄的范围内，创伤性脑损伤的诊断可能是歧视老年人。尽管如此，第1天胶质细胞酸性蛋白在所有年龄类别中具有良好至优异的性能，用于区分所有三个诊断组（曲线下面积0.84-0.96; 95%置信区间的下限均>0.78）。第1天S100钙结合蛋白B和泛素羧基末端水解酶L1仅在40岁以下的成年人中在损伤后6小时内表现出良好的CT阳性与阴性区分。 522例创伤性脑损伤住院患者和24例住院骨科对照患者的纵向血液生物标志物数据可用。胶质细胞酸性蛋白水平在诊断组之间保持良好至极好的区分，直到损伤后第3天，无论年龄大小，直到中年或年轻患者损伤后第5天，直到年轻患者损伤后第2周。总之，在此测试的基于血液的神经胶质细胞酸性蛋白测定在所有年龄类别中具有良好至优异的性能，用于在该创伤中心队列中区分关键创伤性脑损伤诊断组至损伤后至少3天。在创伤性脑损伤（包括老年创伤性脑损伤）的评估中增加基于血液的诊断，有可能简化诊断。Gardner等人报告，基于血液的胶质细胞酸性蛋白水平在关键创伤性脑损伤诊断组中具有良好-极好的区分，直到损伤后第3天，而不考虑年龄，直到中年或年轻患者中的损伤后第5天，以及直到年轻患者中的损伤后第2周。
Older adults have the highest incidence of traumatic brain injury globally. Accurate blood-based biomarkers are needed to assist with diagnosis of patients across the spectrum of age and time post-injury. Several reports have suggested lower accuracy for blood-based biomarkers in older adults, and there is a paucity of data beyond day-1 post-injury. Our aims were to investigate age-related differences in diagnostic accuracy and 2-week evolution of four leading candidate blood-based traumatic brain injury biomarkers—plasma glial fibrillary acidic protein, ubiquitin carboxy-terminal hydrolase L1, S100 calcium binding protein B and neuron-specific enolase—among participants in the 18-site prospective cohort study Transforming Research And Clinical Knowledge in Traumatic Brain Injury. Day-1 biomarker data were available for 2602 participants including 2151 patients with traumatic brain injury, 242 orthopedic trauma controls and 209 healthy controls. Participants were stratified into 3 age categories (young: 17–39 years, middle-aged: 40–64 years, older: 65–90 years). We investigated age-stratified biomarker levels and biomarker discriminative abilities across three diagnostic groups: head CT-positive/negative; traumatic brain injury/orthopedic controls; and traumatic brain injury/healthy controls. The difference in day-1 glial fibrillary acidic protein, ubiquitin carboxy-terminal hydrolase L1 and neuron-specific enolase levels across most diagnostic groups was significantly smaller for older versus younger adults, resulting in a narrower range within which a traumatic brain injury diagnosis may be discriminated in older adults. Despite this, day-1 glial fibrillary acidic protein had good to excellent performance across all age-categories for discriminating all three diagnostic groups (area under the curve 0.84–0.96; lower limit of 95% confidence intervals all >0.78). Day-1 S100 calcium-binding protein B and ubiquitin carboxy-terminal hydrolase L1 showed good discrimination of CT-positive versus negative only among adults under age 40 years within 6 hours of injury. Longitudinal blood-based biomarker data were available for 522 hospitalized patients with traumatic brain injury and 24 hospitalized orthopaedic controls. Glial fibrillary acidic protein levels maintained good to excellent discrimination across diagnostic groups until day 3 post-injury irrespective of age, until day 5 post-injury among middle-aged or younger patients and until week 2 post-injury among young patients only. In conclusion, the blood-based glial fibrillary acidic protein assay tested here has good to excellent performance across all age-categories for discriminating key traumatic brain injury diagnostic groups to at least 3 days post-injury in this trauma centre cohort. The addition of a blood-based diagnostic to the evaluation of traumatic brain injury, including geriatric traumatic brain injury, has potential to streamline diagnosis. Gardner et al. report that blood-based glial fibrillary acidic protein level has good-excellent discrimination across key traumatic brain injury diagnostic groups until day 3 post-injury irrespective of age, until day 5 post-injury among middle-aged or younger patients and until week 2 post-injury among young patients.
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影响因子：
48
作者：
Bazarian, Jeffrey J.;Biberthaler, Peter;Jagoda, Andy S.
通讯作者：
Jagoda, Andy S.
影响因子：
4.2
作者：
NICHOLS, NR;DAY, JR;FINCH, CE
通讯作者：
FINCH, CE
DOI：
10.1186/1757-7241-21-52
发表时间：
2013-07-06
期刊：
Scandinavian journal of trauma, resuscitation and emergency medicine
影响因子：
--
作者：
Calcagnile O;Holmén A;Chew M;Undén J
通讯作者：
Undén J
影响因子：
6.8
作者：
Allouchery, Gautier;Moustafa, Fares;Bouvier, Damien
通讯作者：
Bouvier, Damien
影响因子：
4.2
作者：
Diaz-Arrastia, Ramon;Wang, Kevin K. W.;Vassar, Mary J.
通讯作者：
Vassar, Mary J.