Evaluation of GFAP/UCH-L1 biomarkers for computed tomography exclusion in mild traumatic brain injury (mTBI).

IF 2 Q2 EMERGENCY MEDICINE International Journal of Emergency Medicine Pub Date : 2024-10-24 DOI:10.1186/s12245-024-00708-z
Jacopo M Legramante, Marilena Minieri, Marzia Belli, Alfredo Giovannelli, Alessia Agnoli, Daniela Bajo, Lorenza Bellincampi, Anna Maria De Angelis, Alessandro Terrinoni, Massimo Pieri, Eleonora Nicolai, Vito N Di Lecce, Carla Paganelli, Gianluigi Ferrazza, Susanna Longo, Marco Ciotti, Sergio Bernardini
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Abstract

Introduction: Mild traumatic brain injury (mTBI) represents a major public health concern and affects millions of people worldwide every year. Diagnosis mainly relies on clinical criteria and computed tomography (CT) scans. GFAP (glial fibrillary acidic protein) and UCH-L1 (ubiquitin carboxyl-terminal hydrolase-L1) have been recently studied as potential biomarkers of mTBI. This study retrospectively evaluated the possible use of these combined biomarkers as negative predictors for excluding brain injuries in patients with suspected mTBI in the emergency department.

Methods: Adult patients (n = 130) enrolled at Tor Vergata University Hospital (Rome, Italy), consecutively registered at the triage of the emergency department between October 2022 and January 2023, with non-penetrating TBI and Glasgow Coma Scale (GCS) score of 13-15, were considered. All eligible patients underwent intracranial CT scans and blood tests, within 12 h after trauma, for GFAP and UCH-L1 serum concentrations.

Results: Intracranial CT detected injuries in only seven patients (5%); GFAP and UCH-L1 tested positive in 96 patients and negative in 34 patients (74% vs. 26%). Combined biomarkers had a sensitivity equal to 1.00 (95% CI 0.64-1.00) and a negative predictive value (NPV) of 1.00 (0.99-1.00) in mTBI diagnosis with a negative CT.

Conclusions: Combined laboratory tests for GFAP and UCH-L1 biomarkers might play a potential clinical role in avoiding unnecessary head CT scans after mTBI in emergency departments.

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评估用于排除轻度脑外伤(mTBI)的计算机断层扫描的 GFAP/UCH-L1 生物标记物。
导言:轻度创伤性脑损伤(mTBI)是一个重大的公共卫生问题,每年影响着全球数百万人。诊断主要依靠临床标准和计算机断层扫描(CT)。GFAP(神经胶质纤维酸性蛋白)和 UCH-L1(泛素羧基末端水解酶-L1)作为 mTBI 的潜在生物标记物最近已被研究。本研究回顾性评估了这些组合生物标志物作为排除急诊科疑似 mTBI 患者脑损伤的阴性预测指标的可能性:研究对象为2022年10月至2023年1月期间在Tor Vergata大学医院(意大利罗马)急诊科分诊处连续登记的成年患者(n = 130),这些患者均为非穿透性创伤性脑损伤,格拉斯哥昏迷量表(GCS)评分为13-15分。所有符合条件的患者均在创伤后12小时内接受了颅内CT扫描和血液检测,以检测GFAP和UCH-L1血清浓度:结果:只有 7 名患者(5%)的颅内 CT 检测出损伤;96 名患者的 GFAP 和 UCH-L1 检测呈阳性,34 名患者呈阴性(74% 对 26%)。在 CT 阴性的 mTBI 诊断中,联合生物标志物的灵敏度为 1.00(95% CI 0.64-1.00),阴性预测值为 1.00(0.99-1.00):结论:GFAP和UCH-L1生物标志物的联合实验室检测在急诊科避免mTBI后不必要的头部CT扫描方面可能发挥潜在的临床作用。
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来源期刊
CiteScore
4.60
自引率
0.00%
发文量
63
审稿时长
13 weeks
期刊介绍: The aim of the journal is to bring to light the various clinical advancements and research developments attained over the world and thus help the specialty forge ahead. It is directed towards physicians and medical personnel undergoing training or working within the field of Emergency Medicine. Medical students who are interested in pursuing a career in Emergency Medicine will also benefit from the journal. This is particularly useful for trainees in countries where the specialty is still in its infancy. Disciplines covered will include interesting clinical cases, the latest evidence-based practice and research developments in Emergency medicine including emergency pediatrics.
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