Blood tests taken on the day of traumatic brain injury can predict which patients are likely to die or survive with severe disability, allowing clinicians to make earlier decisions regarding possible treatment for TBI, study finds.
Researchers from Michigan Medicine, the University of California, San Francisco, and the University of Pennsylvania analyzed day-of-injury blood tests from nearly 1,700 patients with TBI. Results published in Lancet Neurology reveal that higher values of two protein biomarkers, GFAP and UCH-L1, are associated with death and serious injury.
This is the first study to examine the association between biomarker levels of these two proteins and all-cause mortality following TBI, says first author Frederick Korley, MD, Ph.D., associate professor of medicine at emergency room at the University of Michigan Medical School.
“Early and accurate prediction of TBI outcomes will help clinicians assess the severity of brain injury and indicate how best to advise family members on what and how to care for loved ones with brain injury. expect when it comes to their recovery,” Korley said. “It will also help researchers more precisely target promising TBI therapies to the right TBI patients. »
The United States Food and Drug Administration approved the use of GFAP and UCH-L1 in 2018 to help clinicians decide whether or not to order CT scans for mild traumatic brain injury.
The researchers measured the proteins using two devices from Abbott Laboratories, the i-STAT Alinity and the ARCHITECT. The results were compared to assessments made six months following the injury using the Glasgow Outcome Scale-Extended, a system that assesses the functional status of TBI patients.
Investigators found that compared to those with GFAP values in the lower 20th percentile, those with GFAP values in the upper 20th percentile had a 23-fold increased risk of death over the next six months. Similarly, compared to those with UCH-L1 values in the lower 20th percentile, those with UCH-L1 values in the upper 20th percentile had a 63-fold increased risk of death over the next 6 months. .
“Modern trauma care can work well in what we once thought were non-survivable injuries,” said co-senior author Geoffrey Manley, MD, Ph.D., professor and vice chair of neurosurgery at the UCSF. “These blood tests are both diagnostic and prognostic, as well as easy to administer, safe and inexpensive. »
While the method shows promise for determining poor outcomes in moderate and severe CBT, the researchers say more needs to be done to examine its role in mild cases.
“As a next step, the TRACK-TBI team is planning a clinical trial that will examine the efficacy of promising therapeutic agents that may help patients with traumatic brain injury recover quickly,” Korley said. “In this clinical trial, these biomarkers will be used as an objective method to select the right patients to enroll in this trial. We will also use these biomarkers to monitor individual patient response to these promising therapies.
Korley was previously a consultant for Abbott Laboratories. Korley and Robertson received research funding from Abbott Laboratories. Manley received research funding from a collaboration between Abbott Laboratories and the US Department of Defense. Diaz-Arrastia has consulted for MesoScale Discoveries, BrainBox Solutions and NovaSignal. All other authors and contributors declare no competing interests.
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Materials provided by Michigan Medicine – University of Michigan. Original written by Noah Fromson. Note: Content may be edited for style and length.