A study finds that blood tests taken the day of a traumatic brain injury can predict which patients are more likely to die or survive with severe disability, allowing clinicians to make decisions earlier on possible treatment of TBI.
Researchers from Michigan Medicine, the University of California San Francisco and the University of Pennsylvania analyzed day-of-injury blood tests of nearly 1,700 patients with TBI. Results published in The Lancet Neurology reveal that higher values of two protein biomarkers, GFAP and UCH-L1, are related to death and severe injury.
That is the primary study to look at the association between biomarker levels of those two proteins and all-cause mortality following TBI, says first creator Frederick Korley, M.D., Ph.D., associate professor of emergency medicine on the University of Michigan Medical School.
Early and accurate prediction of TBI outcomes will help clinicians gauge how severe a brain injury is and inform how best to counsel members of the family about look after their family members with brain injury and what to anticipate with reference to their recovery. It would also help researchers more precisely goal promising TBI therapeutics to the fitting TBI patients.”
Frederick Korley, M.D., Ph.D., associate professor of emergency medicine, University of Michigan Medical School
The U.S. Food and Drug Administration cleared the usage of GFAP and UCH-L1 in 2018 to assist clinicians resolve whether to order CT scans for mild traumatic brain injury.
Researchers measured the proteins using two devices from Abbott Laboratories, the i-STAT Alinity and the ARCHITECT. Results were in comparison with evaluations made six months after injury using the Glasgow Final result Scale-Prolonged, a system that grades the functional status of TBI patients.
Investigators found that in comparison with those with GFAP values in the underside twentieth percentile, those with GFAP values in the highest twentieth percentile had a 23 times higher risk of death in the course of the subsequent six months. Similarly, in comparison with those with UCH-L1 values in the underside twentieth percentile, those with UCH-L1 values in the highest twentieth percentile had a 63 times higher risk of death in the course of the subsequent 6 months.
“Modern trauma care may end up in good outcomes in what we had once believed were non-survivable injuries,” said co-senior creator Geoffrey Manley, M.D., Ph.D., professor and vice chair of neurosurgery at UCSF. “These blood tests are each diagnostic and prognostic, in addition to easy to manage, protected and cheap.”
While the tactic is promising for determining poor outcomes in moderate and severe TBI, researchers say more should be done to look at its role in mild cases.
“As a next step, the TRACK-TBI team is planning a clinical trial that can examine the efficacy of promising therapeutic agents which will help traumatic brain injury patients recuperate quickly,” Korley said. “As a part of this clinical trial, these biomarkers shall be used as an objective method for choosing the fitting patients to enroll on this trial. We can even use these biomarkers to watch individual patient response to those promising therapeutics.”
Source:
Michigan Medicine – University of Michigan
Journal reference:
Korley, F.K., et al. (2022) Prognostic value of day-of-injury plasma GFAP and UCH-L1 concentrations for predicting functional recovery after traumatic brain injury in patients from the US TRACK-TBI cohort: an observational cohort study. The Lancet Neurology. doi.org/10.1016/S1474-4422(22)00256-3.