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Glial Fibrillary Acidic Protein and Ubiquitin C-Terminal Hydrolase-L1 as Outcome Predictors in Traumatic Brain Injury.

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Takala, RSK 
Posti, JP 
Runtti, H 
Newcombe, VF 
Outtrim, JG 


OBJECTIVE: Biomarkers ubiquitin C-terminal hydrolase-L1 (UCH-L1) and glial fibrillary acidic protein (GFAP) may help detect brain injury, assess its severity, and improve outcome prediction. This study aimed to evaluate the prognostic value of these biomarkers during the first days after brain injury. METHODS: Serum UCH-L1 and GFAP were measured in 324 patients with traumatic brain injury (TBI) enrolled in a prospective study. The outcome was assessed using the Glasgow Outcome Scale (GOS) or the extended version, Glasgow Outcome Scale-Extended (GOSE). RESULTS: Patients with full recovery had lower UCH-L1 concentrations on the second day and patients with favorable outcome had lower UCH-L1 concentrations during the first 2 days compared with patients with incomplete recovery and unfavorable outcome. Patients with full recovery and favorable outcome had significantly lower GFAP concentrations in the first 2 days than patients with incomplete recovery or unfavorable outcome. There was a strong negative correlation between outcome and UCH-L1 in the first 3 days and GFAP levels in the first 2 days. On arrival, both UCH-L1 and GFAP distinguished patients with GOS score 1-3 from patients with GOS score 4-5, but not patients with GOSE score 8 from patients with GOSE score 1-7. For UCH-L1 and GFAP to predict unfavorable outcome (GOS score ≤ 3), the area under the receiver operating characteristic curve was 0.727, and 0.723, respectively. Neither UCHL-1 nor GFAP was independently able to predict the outcome when age, worst Glasgow Coma Scale score, pupil reactivity, Injury Severity Score, and Marshall score were added into the multivariate logistic regression model. CONCLUSIONS: GFAP and UCH-L1 are significantly associated with outcome, but they do not add predictive power to commonly used prognostic variables in a population of patients with TBI of varying severities.



Biomarkers, GFAP, Outcome, Traumatic brain injury, UCH-L1, Adolescent, Adult, Aged, Area Under Curve, Biomarkers, Brain Injuries, Female, Glasgow Coma Scale, Glial Fibrillary Acidic Protein, Humans, Injury Severity Score, Logistic Models, Male, Middle Aged, Predictive Value of Tests, Prognosis, Prospective Studies, ROC Curve, Ubiquitin Thiolesterase, Young Adult

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World Neurosurgery

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Medical Research Council (G9439390)
TCC (None)
This work was partially funded by the European Commission under the 7th Framework Programme (FP7-270259-TBIcare), the United Kingdom National Institute of Health Research Biomedical Research Centre at Cambridge, and a personal EVO grant (R.S.K.T.) from Hospital District of South-West Finland. V.F.N. is supported by a Health Foundation/Academy of Medical Sciences Clinician Scientist Fellowship. J.O., J.P.C., P.H., and D.K.M. were supported by the United Kingdom National Institute of Health Research Biomedical Research Centre at Cambridge, and D.K.M. was also supported by a Senior Investigator Award from the United Kingdom National Institute of Health Research.