A study finds that blood tests taken on the day of a traumatic brain injury can predict which patients are likely to die or survive with severe disability, allowing doctors to make earlier decisions about possible TBI treatment.
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 TBI patients. Results published in The Lancet Neurology reveal that higher values of two protein biomarkers, GFAP and UCH-L1, are associated with death and severe injury.
This is the first study to examine the association between biomarker levels of these two proteins and all-cause mortality after TBI, says first author Frederick Korley, MD, Ph.D., associate professor of emergency medicine at the University of Michigan Medical School.
Early and accurate prediction of TBI outcomes will help clinicians assess the severity of a brain injury and inform how best to counsel family members about caring for their loved ones with brain injury and what to expect for what about his recovery. It will also help researchers more precisely target promising TBI therapeutics to the right TBI patients.”
Frederick Korley, MD, Ph.D., Associate Professor of Emergency Medicine, University of Michigan Medical School
The US Food and Drug Administration cleared the use of GFAP and UCH-L1 in 2018 to help doctors decide whether to order CT 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 with assessments made six months after the injury using the Glasgow Outcome Scale-Extended, a system that classifies the functional status of patients with TBI.
The researchers 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 in the following six months. Similarly, compared with those with UCH-L1 values in the lower 20th percentile, those with UCH-L1 values in the upper 20th percentile had a 63-fold greater risk of death during the subsequent 6 months.
“Modern trauma care can lead to good outcomes 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 UCSF. “These blood tests are both diagnostic and prognostic, as well as easy to administer, safe and inexpensive.”
While the method shows promise in determining poor outcomes in moderate and severe TBI, the researchers say more needs to be done to examine its role in milder cases.
“As a next step, the TRACK-TBI team is planning a clinical trial that will examine the effectiveness of promising therapeutic agents that can help TBI patients recover quickly,” Korley said. “As part of 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 therapeutics.”
Source:
Michigan Medicine – University of Michigan
Journal reference:
Korley, FK, et al. (2022) Prognostic value of day-of-injury plasma concentrations of GFAP and UCH-L1 in 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.