• Jussi P Posti, Takala Riikka S K RSK 2 Turku Brain Injury Center, Turku University Hospital, Turku, Finland. 4 Perioper, Linnéa Lagerstedt, Alex M Dickens, Iftakher Hossain, Mehrbod Mohammadian, Henna Ala-Seppälä, Janek Frantzén, Mark van Gils, Peter J Hutchinson, Ari J Katila, Henna-Riikka Maanpää, David K Menon, Virginia F Newcombe, Jussi Tallus, Kevin Hrusovsky, David H Wilson, Jessica Gill, Jean-Charles Sanchez, Olli Tenovuo, Henrik Zetterberg, and Kaj Blennow.
• 1 Department of Neurosurgery, Turku University Hospital, Turku, Finland.
• J. Neurotrauma. 2019 Jul 15; 36 (14): 2178-2189.

AbstractThe aim of the study was to examine the ability of eight protein biomarkers and their combinations in discriminating computed tomography (CT)-negative and CT-positive patients with traumatic brain injury (TBI), utilizing highly sensitive immunoassays in a well-characterized cohort. Blood samples were obtained from 160 patients with acute TBI within 24 h of 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 Scale [GCS] score 3-15) and mild TBIs (mTBIs; GCS 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 outperform individual biomarkers in separating CT-negative and CT-positive patients. Panels consisted mainly of different biomarkers than those that performed best as an individual biomarker.

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