GFAP Out-Performs S100β in Detecting Traumatic Intracranial Lesions on Computed Tomography in Trauma Patients with Mild Traumatic Brain Injury and Those with Extracranial Lesions

Abstract

Both glial fibrillary acidic protein (GFAP) and S100β are found in glial cells and are released into serum following a traumatic brain injury (TBI), however, the clinical utility of S100β as a biomarker has been questioned because of its release from bone. This study examined the ability of GFAP and S100β to detect intracranial lesions on computed tomography (CT) in trauma patients and also assessed biomarker performance in patients with fractures and extracranial injuries on head CT. This prospective cohort study enrolled a convenience sample of adult trauma patients at a Level I trauma center with and without mild or moderate traumatic brain injury (MMTBI). Serum samples were obtained within 4 h of injury. The primary outcome was the presence of traumatic intracranial lesions on CT scan. There were 397 general trauma patients enrolled: 209 (53%) had a MMTBI and 188 (47%) had trauma without MMTBI. Of the 262 patients with a head CT, 20 (8%) had intracranial lesions. There were 137 (35%) trauma patients who sustained extracranial fractures below the head to the torso and extremities. Levels of S100β were significantly higher in patients with fractures, compared with those without fractures (p<0.001) whether MMTBI was present or not. However, GFAP levels were not significantly affected by the presence of fractures (p>0.05). The area under the receiver operating characteristics curve (AUC) for predicting intracranial lesions on CT for GFAP was 0.84 (0.73-0.95) and for S100β was 0.78 (0.67-0.89). However, in the presence of extracranial fractures, the AUC for GFAP increased to 0.93 (0.86-1.00) and for S100β decreased to 0.75 (0.61-0.88). In a general trauma population, GFAP out-performed S100β in detecting intracranial CT lesions, particularly in the setting of extracranial fractures.

In Children and Youth with Mild and Moderate Traumatic Brain Injury, Glial Fibrillary Acidic Protein Out-Performs S100β in Detecting Traumatic Intracranial Lesions on Computed Tomography

“…19 A recently published study in 397 adult trauma patients compared the performance of S100b with GFAP in predicting intracranial lesions on CT in the presence of torso and limb fractures. 18 Overall, GFAP out-performed S100b in detecting CT lesions and did considerably better in detecting such lesion in multiple trauma when extracranial fractures were present. GFAP is detectable in serum in less than 1 h after a mild TBI and can distinguish mild TBI patients from other trauma patients.…”

“…13,14 Glial fibrillary acidic protein (GFAP) has been shown to be a promising brain-specific biomarker for mild TBI. [15][16][17][18] GFAP is a monomeric intermediate protein that was first isolated by Eng and colleagues in 1971 and found in astroglial skeleton in both white and gray brain matter. 19 A recently published study in 397 adult trauma patients compared the performance of S100b with GFAP in predicting intracranial lesions on CT in the presence of torso and limb fractures.…”

Serum glial fibrillary acidic protein as a marker of brain damage in patients after carotid endarterectomy

“…Moreover, any increase in the level of serum GFAP can depend on the magnitude of brain damage and its duration. It was observed that serum GFAP level was increased in different neurological diseases with characteristic persistent and chronic brain damage, including multiple sclerosis, glioblastoma, Parkinson disease, traumatic brain injury, and subarachnoid haemorrhage [13][14][15][16][17][18].…”

Current State and Prospects of Development of Blood-based Biomarkers for Mild Traumatic Brain Injury

“…The GFAP blood concentrations in patients with mTBI in the emergency department is better than the s100B blood concentrations in predicting the need for brain CT. Especially, in cases of extracranial injuries, GFAP blood concentrations were also found to have a higher specificity for detecting lesions that could be confirmed with brain CT [77]. In addition, in 2 reviews, the concentrations of GFAP correlated with the initial GCS scores, as with s100B [59,60].…”