JOURNAL OF NEUROTRAUMA | FEBRUARY 25, 2019

Posti JP, Takala RS, Lagerstedt L, Dickens AM, Hossain I, Mohammadian M, Ala-Seppala HM, Frantzen J, Van Gils M, Hutchinson PJ, Katila AJ, Maanpaa HR, Menon D, Newcombe V, Tallus J, Hrusovsky K, Wilson D, Gill J, Sanchez JC, Tenovuo O, Zetterberg H and Blennow K.

J Neurotrauma. 2019 Feb 14

DOI: 10.1089/neu.2018.6254

ABSTRACT

The aim of the study was to examine the ability of eight protein biomarkers and their combinations in discriminating CT-negative and CT-positive patients with TBI, utilizing highly sensitive immunoassays in a well-characterized cohort. Blood samples were obtained from 160 patients with acute TBI within 24h from admission. Levels of β-amyloid isoforms 1-40 (Aβ40) and 1-42 (Aβ42), glial fibrillary acidic protein (GFAP), heart fatty-acid binding protein (H-FABP), interleukin 10 (IL-10), neurofilament light (NF-L), S100 calcium-binding protein B (S100B) and tau were measured. Patients were divided into CT-negative (n=65) and CT-positive (n=95), and analyses were conducted separately for TBIs of all severities (Glasgow Coma Score 3-15) and mild TBIs (mTBI, Glasgow Coma Score 13-15). NF-L, GFAP and tau were the best in discriminating CT-negative and CT-positive patients, both in patients with mTBI and with all severities. In patients with all severities, area under the curve of the receiver operating characteristic (AUC) was 0.822, 0.817, and 0.781 for GFAP, NF-L and tau, respectively. In patients with mTBI, AUC was 0.720, 0.689 and 0.676, for GFAP, tau and NF-L, respectively. The best panel of three biomarkers for discriminating CT-negative and CT-positive patients in the group of all severities was a combination of GFAP+H-FABP+IL-10, with a sensitivity of 100% and specificity of 38.5%. In patients with mTBI, the best panel of three biomarkers was H-FABP+S100B+tau, with a sensitivity of 100% and specificity of 46.4%. Panels of biomarkers, sampled within 24 hours from the injury, outperform individual biomarkers in separating CT-negative and CT-positive patients. Panels consisted of mainly different biomarkers than those, which performed best as an individual biomarker.