Abstract
Background: Blood biomarkers may enhance outcome prediction performance of head computed tomography scores in traumatic brain injury (TBI).Objective: To investigate whether admission levels of eight different protein biomarkers can improve the outcome prediction performance of the Helsinki computed tomography score (HCTS) without clinical covariates in TBI.Materials and methods: Eighty-two patients with computed tomography positive TBIs were included in this study. Plasma levels of β-amyloid isoforms 1–40 (Aβ40) and 1–42 (Aβ42), glial fibrillary acidic protein, heart fatty acid-binding protein, interleukin 10 (IL-10), neurofilament light, S100 calcium-binding protein B, and total tau were measured within 24 h from admission. The patients were divided into favorable (Glasgow Outcome Scale—Extended 5–8, n = 49) and unfavorable (Glasgow Outcome Scale—Extended 1–4, n = 33) groups. The outcome was assessed 6–12 months after injury. An optimal predictive panel was investigated with the sensitivity set at 90–100%.Results: The HCTS alone yielded a sensitivity of 97.0% (95% CI: 90.9–100) and specificity of 22.4% (95% CI: 10.2–32.7) and partial area under the curve of the receiver operating characteristic of 2.5% (95% CI: 1.1–4.7), in discriminating patients with favorable and unfavorable outcomes. The threshold to detect a patient with unfavorable outcome was an HCTS > 1. The three best individually performing biomarkers in outcome prediction were Aβ40, Aβ42, and neurofilament light. The optimal panel included IL-10, Aβ40, and the HCTS reaching a partial area under the curve of the receiver operating characteristic of 3.4% (95% CI: 1.7–6.2) with a sensitivity of 90.9% (95% CI: 81.8–100) and specificity of 59.2% (95% CI: 40.8–69.4).Conclusion: Admission plasma levels of IL-10 and Aβ40 significantly improve the prognostication ability of the HCTS after TBI.
Highlights
Traumatic brain injury (TBI) is a highly heterogeneous disease [1] and a leading cause of long-term disability globally [2]
The threshold to detect a patient with unfavorable outcome was an Helsinki CT Score (HCTS) sum of >1 (Table 3)
The results presented here suggest that protein biomarkers IL-10 and Aβ40 provide incremental value in outcome prediction when used in
Summary
Traumatic brain injury (TBI) is a highly heterogeneous disease [1] and a leading cause of long-term disability globally [2]. It is clear that outcome after TBI solely does not depend only on the given care in the acute and late phases, and on the injury type and severity, patient’s clinical characteristics, and eventual brain tissue fate [3, 4]. TBI is classically divided into mild, moderate, and severe based on the initial assessment using the Glasgow Coma Scale (GCS) score upon admission [5]. The GCS score is one of the strongest clinical outcome predictors [3] but does not consider the complex pathophysiological characteristics of TBI. Blood biomarkers may enhance outcome prediction performance of head computed tomography scores in traumatic brain injury (TBI)
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