A Role of Serum-Based Neuronal and Glial Markers as Potential Predictors for Distinguishing Severity and Related Outcomes in Traumatic Brain Injury

Abstract

ObjectiveOptimal treatment decision and estimation of the prognosis in traumatic brain injury (TBI) is currently based on demographic and clinical predictors. But sometimes, there are limitations in these factors. In this study, we analyzed three central nervous system biomarkers in TBI patients, will discuss the roles and clinical applications of biomarkers in TBI.MethodsFrom July on 2013 to August on 2014, a total of 45 patients were included. The serum was obtained at the time of hospital admission, and biomarkers were extracted with centrifugal process. It was analyzed for the level of S-100 beta (S100B), glial fibrillary acidic protein (GFAP), and ubiquitin carboxy-terminal hydrolase-L1 (UCH-L1).ResultsThis study included 33 males and 12 females with a mean age of 58.5 (19-84) years. TBI patients were classified into two groups. Group A was severe TBI with Glasgow Coma Scale (GCS) score 3-5 and Group B was mild TBI with GCS score 13-15. The median serum concentration of S100B, GFAP, and UCH-L1 in severe TBI were raised 5.1 fold, 5.5 fold, and 439.1 fold compared to mild injury, respectively. The serum levels of these markers correlated significantly with the injury severity and clinical outcome (p<0.001). Increased level of markers was strongly predicted poor outcomes.ConclusionS100B, GFAP, and UCH-L1 serum level of were significantly increased in TBI according to severity and associated clinical outcomes. Biomarkers have potential utility as diagnostic, prognostic, and therapeutic adjuncts in the setting of TBI.

Biomarkers of Traumatic Brain Injury: Temporal Changes in Body Fluids

“…However, several studies confirm the high specificity of GFAP to brain injuries in comparison to other biomarkers such as S100β and neuron-specific enolase (Honda et al, 2010; Papa et al, 2014, 2016b). The concentration of GFAP in serum differs between patients that have a GCS value of 3–5 and 13–15, and thus, GFAP has diagnostic potential to discriminate between severe and mild cases of TBI (Lee et al, 2015). Acute GFAP levels correlate with the recovery and outcome of the patient (Mannix et al, 2014; Takala et al, 2016), although in mTBI cases, the predictive value was found to be weaker (Metting et al, 2012).…”

Blood biomarkers for evaluation of perinatal encephalopathy: state of the art

“…Glial injury can be assessed by GFAP in the blood and axonal injury by C-Tau and spectrin protein breakdown products (Guingab-Cagmat et al, 2013). The serum levels of glial and neuronal biomarkers (S100B, GFAP, UCHL1) at the time of admission after brain injury have been shown to correlate with clinical outcome and are sensitive and specific in determining the severity of injury (Lee et al, 2015). With UCHL1 levels increasing in diffuse injury and GFAP levels increasing in focal injury, a glial:neuronal ratio has been proposed as a novel indicator to differentiate focal and diffuse injury, and has been found to be more accurate when measured at < 12 h after injury (Mondello et al, 2012a).…”

“…The brain consists of many elements, and depending on the mechanism and severity of injury, various damage patterns may be reflected by different combinations of biomarkers (Lee et al, 2015). Biomarkers will probably supplement existing tools, such as the Glascow Coma Scale and neuroimaging, for the initial classification of brain injury in the near future (Papa et al, 2008).…”

Potentialities of evaluation of serum level of S100B for predicting the consequences of severe traumatic brain injury

“…Прогнозування наслідків ЧМТ у тепе-рішній час ґрунтується на таких даних демографічних, клінічних і радіологічних досліджень, як, зокрема, вік, показники шкали коми Глазго при госпіталізації потер-пілих, реакція зіниць, вітальні функції, наявність поза-черепних ушкоджень, результати комп'ютерної томог-рафії (КТ). Прогнозування з використанням клінічних даних може мати обмеження, оскільки на них впливає застосування певних лікарських засобів (аналгетиків, седативних, міорелаксантів тощо), а радіологічні дані в деяких ситуаціях не відповідають клінічним проявам, наприклад, при дифузному ушкодженні головного мозку за відсутності вогнищевої травми [5]. Зазначене спонукає до пошуку таких біомаркерів ушкодження нервової тканини, які точно й специфічно відображали б характер і тяжкість травми.…”