학술논문
Serum biomarkers identify critically ill traumatic brain injury patients for MRI
Document Type
Report
Author
Richter, Sophie; Winzeck, Stefan; Czeiter, Endre; Amrein, Krisztina; Kornaropoulos, Evgenios N.; Verheyden, Jan; Sugar, Gabriela; Yang, Zhihui; Wang, Kevin; Maas, Andrew I. R.; Steyerberg, Ewout; Büki, András; Newcombe, Virginia F. J.; Menon, David K.; Andelic, Nada; Andreassen, Lasse; Anke, Audny; Azouvi, Philippe; Bellander, Bo-Michael; Benali, Habib; Buki, Andras; Caccioppola, Alessio; Calappi, Emiliana; Carbonara, Marco; Citerio, Giuseppe; Clusmann, Hans; Coburn, Mark; Coles, Jonathan; Correia, Marta; De Keyser, Véronique; Degos, Vincent; Depreitere, Bart; Eikenes, Live; Ezer, Erzsébet; Foks, Kelly; Frisvold, Shirin; Galanaud, Damien; Ghuysen, Alexandre; Glocker, Ben; Haberg, Asta; Haitsma, Iain; Helseth, Eirik; Hutchinson, Peter J.; Kornaropoulos, Evgenios; Kovács, Noémi; Kowark, Ana; Laureys, Steven; Ledoux, Didier; Lingsma, Hester; Manley, Geoffrey; Menovsky, Tomas; Misset, Benoit; Muraleedharan, Visakh; Nakken, Ingeborg; Newcombe, Virginia; Nordhay, Wibeke; Nyirádi, József; Ortolano, Fabrizio; Parizel, Paul M.; Perlbarg, Vincent; Persona, Paolo; Peul, Wilco; Posti, Jussi P.; Puybasset, Louis; Roe, Cecilie; Roise, Olav; Rossaint, Rolf; Rossi, Sandra; Rueckert, Daniel; Skandsen, Toril; Sorinola, Abayomi; Stamatakis, Emmanuel; Steyerberg, Ewout W.; Stocchetti, Nino; Takala, Riikka; Tamás, Viktória; Tenovuo, Olli; Vámos, Zoltán; Van der Steen, Gregory; Van Hecke, Wim; Vyvere, Thijs Vande; Vik, Anne; Volovici, Victor; Westlye, Lars T.; Williams, Guy; Ylén, Peter; Zoerle, Tommaso
Source
Critical Care. November 29, 2022, Vol. 26 Issue 1
Subject
Language
English
ISSN
1364-8535
Abstract
Author(s): Sophie Richter[sup.1] , Stefan Winzeck[sup.1,2] , Endre Czeiter[sup.3,4,5] , Krisztina Amrein[sup.3,4,5] , Evgenios N. Kornaropoulos[sup.6] , Jan Verheyden[sup.7] , Gabriela Sugar[sup.8] , Zhihui Yang[sup.9] , Kevin Wang[sup.9] , Andrew [...]
Background Magnetic resonance imaging (MRI) carries prognostic importance after traumatic brain injury (TBI), especially when computed tomography (CT) fails to fully explain the level of unconsciousness. However, in critically ill patients, the risk of deterioration during transfer needs to be balanced against the benefit of detecting prognostically relevant information on MRI. We therefore aimed to assess if day of injury serum protein biomarkers could identify critically ill TBI patients in whom the risks of transfer are compensated by the likelihood of detecting management-altering neuroimaging findings. Methods Data were obtained from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. Eligibility criteria included: TBI patients aged [greater than or equal to] 16 years, Glasgow Coma Score (GCS) < 13 or patient intubated with unrecorded pre-intubation GCS, CT with Marshall score < 3, serum biomarkers (GFAP, NFL, NSE, S100B, Tau, UCH-L1) sampled [less than or equai to] 24 h of injury, MRI < 30 days of injury. The degree of axonal injury on MRI was graded using the Adams-Gentry classification. The association between serum concentrations of biomarkers and Adams-Gentry stage was assessed and the optimum threshold concentration identified, assuming different minimum sensitivities for the detection of brainstem injury (Adams-Gentry stage 3). A cost-benefit analysis for the USA and UK health care settings was also performed. Results Among 65 included patients (30 moderate-severe, 35 unrecorded) axonal injury was detected in 54 (83%) and brainstem involvement in 33 (51%). In patients with moderate-severe TBI, brainstem injury was associated with higher concentrations of NSE, Tau, UCH-L1 and GFAP. If the clinician did not want to miss any brainstem injury, NSE could have avoided MRI transfers in up to 20% of patients. If a 94% sensitivity was accepted considering potential transfer-related complications, GFAP could have avoided 30% of transfers. There was no added net cost, with savings up to [pounds sterling]99 (UK) or $612 (US). No associations between proteins and axonal injury were found in intubated patients without a recorded pre-intubation GCS. Conclusions Serum protein biomarkers show potential to safely reduce the number of transfers to MRI in critically ill patients with moderate-severe TBI at no added cost. Keywords: Traumatic brain injury, Traumatic axonal injury, Diffuse axonal injury, Magnetic resonance imaging, Glasgow Coma Scale, Serum protein biomarkers, Neuron-specific enolase (NSE), Tau, Ubiquitin C terminal hydrolase L1 (UCH-L1), Glial fibrillary acidic protein (GFAP)
Background Magnetic resonance imaging (MRI) carries prognostic importance after traumatic brain injury (TBI), especially when computed tomography (CT) fails to fully explain the level of unconsciousness. However, in critically ill patients, the risk of deterioration during transfer needs to be balanced against the benefit of detecting prognostically relevant information on MRI. We therefore aimed to assess if day of injury serum protein biomarkers could identify critically ill TBI patients in whom the risks of transfer are compensated by the likelihood of detecting management-altering neuroimaging findings. Methods Data were obtained from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. Eligibility criteria included: TBI patients aged [greater than or equal to] 16 years, Glasgow Coma Score (GCS) < 13 or patient intubated with unrecorded pre-intubation GCS, CT with Marshall score < 3, serum biomarkers (GFAP, NFL, NSE, S100B, Tau, UCH-L1) sampled [less than or equai to] 24 h of injury, MRI < 30 days of injury. The degree of axonal injury on MRI was graded using the Adams-Gentry classification. The association between serum concentrations of biomarkers and Adams-Gentry stage was assessed and the optimum threshold concentration identified, assuming different minimum sensitivities for the detection of brainstem injury (Adams-Gentry stage 3). A cost-benefit analysis for the USA and UK health care settings was also performed. Results Among 65 included patients (30 moderate-severe, 35 unrecorded) axonal injury was detected in 54 (83%) and brainstem involvement in 33 (51%). In patients with moderate-severe TBI, brainstem injury was associated with higher concentrations of NSE, Tau, UCH-L1 and GFAP. If the clinician did not want to miss any brainstem injury, NSE could have avoided MRI transfers in up to 20% of patients. If a 94% sensitivity was accepted considering potential transfer-related complications, GFAP could have avoided 30% of transfers. There was no added net cost, with savings up to [pounds sterling]99 (UK) or $612 (US). No associations between proteins and axonal injury were found in intubated patients without a recorded pre-intubation GCS. Conclusions Serum protein biomarkers show potential to safely reduce the number of transfers to MRI in critically ill patients with moderate-severe TBI at no added cost. Keywords: Traumatic brain injury, Traumatic axonal injury, Diffuse axonal injury, Magnetic resonance imaging, Glasgow Coma Scale, Serum protein biomarkers, Neuron-specific enolase (NSE), Tau, Ubiquitin C terminal hydrolase L1 (UCH-L1), Glial fibrillary acidic protein (GFAP)