The results of a study indicate that blood tests obtained on the day after a traumatic brain injury can predict which patients would die or live with significant disability, allowing clinicians to make treatment options for TBI early.
Nearly 1,700 individuals with TBI had their day-of-injury blood tests evaluated by researchers from Michigan Medicine, the University of California, San Francisco, and the University of Pennsylvania. The Lancet Neurology reveals that elevated levels of two protein biomarkers, GFAP and UCH-L1, correlate with mortality and serious damage.
First author Frederick Korley, M.D., Ph.D., associate professor of emergency medicine at the University of Michigan Medical School, notes that this is the first study to investigate the relationship between biomarker levels of these two proteins and all-cause mortality following TBI.
Early and precise prediction of TBI outcomes can assist physicians in determining the severity of a brain injury and in advising family members on how to care for loved ones with a brain injury and what to expect for their recovery. It will also assist researchers in targeting promising TBI therapies to the appropriate TBI patients.”
Associate professor of emergency medicine at the University of Michigan Medical School is Frederick Korley, M.D., Ph.D.
In 2018, the U.S. Food and Drug Administration authorised the use of GFAP and UCH-L1 to assist doctors in determining whether to obtain CT scans for mild traumatic brain injury.
The proteins were measured with two instruments from Abbott Laboratories: the i-STAT Alinity and the ARCHITECT. Using the Glasgow Outcome Scale-Extended, a grading system for the functional state of TBI patients, the results were compared to assessments done six months after injury.
Compared to those with GFAP values in the lowest 20th percentile, those with GFAP values in the highest 20th percentile had a 23-fold increased risk of death during the next six months. Similarly, compared to those with UCH-L1 values in the lowest 20th percentile, those with UCH-L1 values in the highest 20th percentile had a 63-fold increased risk of dying during the next six months.
Geoffrey Manley, M.D., Ph.D., professor and vice chair of neurosurgery at UCSF, and co-author of the study, stated, “Modern trauma care can result in favourable outcomes for injuries that were once thought to be fatal.” These blood tests are diagnostic and predictive, as well as simple, safe, and economical to conduct.
While the strategy is promising for predicting bad outcomes in moderate and severe TBI, additional research is required to determine its function in mild instances, according to the researchers.
“As a next step, the TRACK-TBI team is organising a clinical trial to assess the efficacy of promising therapeutic drugs that may aid in the rapid recovery of traumatic brain injury patients,” Korley stated. “As part of this clinical trial, these biomarkers will be employed as an objective way for choosing the appropriate participants. These biomarkers will also be used to monitor the response of individual patients to these potential therapies.”
Korley, F.K., et al. (2022) Prognostic value of day-of-injury plasma GFAP and UCH-L1 concentrations for 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.