Serum GFAP and UCH-L1 for prediction of absence of intracranial injuries on head CT (ALERT-TBI): a multicentre observational study
Serum GFAP and UCH-L1 for prediction of absence of intracranial injuries on head CT (ALERT-TBI): a multicentre observational study
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DOI：
10.1016/s1474-4422(18)30231-x
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发表时间：
2018-09-01
期刊：
影响因子：
48
通讯作者：
Jagoda, Andy S.
中科院分区：
文献类型：
--
作者：
Bazarian, Jeffrey J.;Biberthaler, Peter;Jagoda, Andy S.
背景：全世界每年有超过5000万人遭受创伤性脑损伤(TBI)。颅脑损伤的检测依赖于过度使用和资源密集型的头部CT。以血液为基础的脑生物标志物有可能预测无颅内损伤，从而减少不必要的头部CT扫描。我们试图验证一种结合泛素C末端水解酶-L1(UCH-L1)和胶质纤维酸性蛋白(GFAP)的测试，在预定的截断值下，可以在颅脑损伤后急性头部CT扫描上预测创伤性颅内损伤。方法：这项前瞻性的多中心观察性试验包括在急诊科就诊的成人(年龄=18岁)，怀疑为非穿透性脑外伤，格拉斯哥昏迷评分为9-15分。如果患者在受伤后12小时内接受了头部CT检查，作为标准紧急护理的一部分，并采集了血液，则符合条件。测定血清中UCH-L1和GFAP的浓度，并分别以327pg/mL和22pg/mL为临界值进行分析。将UCH-L1和GFAP检测结果合并为一个测试结果，并与头部CT结果进行比较。主要研究结果为颅脑CT检测外伤性颅内损伤的敏感性和阴性预测值(NPV)。研究对象为2012年12月6日至2014年3月20日的1977例患者，其中1959例具有可分析的数据。125例(6%)患者有CT发现的颅内损伤，8例(
Background More than 50 million people worldwide sustain a traumatic brain injury (TBI) annually. Detection of intracranial injuries relies on head CT, which is overused and resource intensive. Blood-based brain biomarkers hold the potential to predict absence of intracranial injury and thus reduce unnecessary head CT scanning. We sought to validate a test combining ubiquitin C-terminal hydrolase-L1 (UCH-L1) and glial fibrillary acidic protein (GFAP), at predetermined cutoff values, to predict traumatic intracranial injuries on head CT scan acutely after TBI.Methods This prospective, multicentre observational trial included adults (>= 18 years) presenting to participating emergency departments with suspected, non-penetrating TBI and a Glasgow Coma Scale score of 9-15. Patients were eligible if they had undergone head CT as part of standard emergency care and blood collection within 12 h of injury. UCH-L1 and GFAP were measured in serum and analysed using prespecified cutoff values of 327 pg/mL and 22 pg/mL, respectively. UCH-L1 and GFAP assay results were combined into a single test result that was compared with head CT results. The primary study outcomes were the sensitivity and the negative predictive value (NPV) of the test result for the detection of traumatic intracranial injury on head CT.Findings Between Dec 6, 2012, and March 20, 2014, 1977 patients were recruited, of whom 1959 had analysable data. 125 (6%) patients had CT-detected intracranial injuries and eight (