High sensitivity C-reactive protein: Potential biomarker of inflammation in acute mTBI

Abstract

ObjectiveThis study investigated the utility of high-sensitivity C-Reactive Protein (hsCRP) as a blood biomarker for mild traumatic brain injury (mTBI).BackgroundValidation of a blood biomarker panel will greatly improve mTBI diagnosis and prognosis. hsCRP has been validated as a sensitive biomarker for inflammation. Previous studies have established relationships between CRP levels and TBI, but the utilization of hsCRP levels in assessing mTBI requires further exploration.MethodsRetrospective chart review collected hsCRP values in acute mTBI patients seen within 30 days of injury. Patients with any comorbid diagnosis known to cause elevation of inflammatory proteins were excluded. Continuous hsCRP levels were transformed into quartiles: <0.200 mg/L for Quartile 1 (Q1); 0.200–0.415 mg/L for Quartile 2 (Q2); 0.415–1.100 mg/L for Quartile 3 (Q3); and ≥1.100 mg/L for Quartile 4 (Q4). Multivariable binary logistic regression modeling identified potential factors for elevated hsCRP at first visit. Cox regression analysis identified potential factors for delayed time to recovery.ResultsThree hundred twelve injuries in 311 patients were reviewed (mean age 21 ± 12 years, 53% female). Mean hsCRP was elevated patients who presented within 2 days of injury and was found to significantly decrease between first visit and 4 weeks post-injury (p = 0.016). Initial hsCRP level was positively correlated with age (r = 0.163, p = 0.004) and negatively associated with previous concussion history (p = 0.031). When analyzed as quartiles, patients in Q4 were more likely to have endorsed headache (p = 0.036) or fatigue (p = 0.030). Age significantly increased between quartiles (p = 0.013). Multivariable binary logistic regression showed that increased age (OR: 3.48) and patients presenting with headache (OR: 3.48) or fatigue (OR: 2.16) were significantly associated with increased risk of having an hsCRP level in Q4. Females (HR: 0.32) and increased age (HR: 0.95) were associated delayed time to recovery.ConclusionshsCRP may be a viable addition to acute and longitudinal biomarker panels for diagnosis and prognosis of mTBI.