Research Reports - A blood-based biomarker panel to risk-stratify mild traumatic brain injury

PLoS One. 2017 Mar 29;12(3):e0173798. doi: 10.1371/journal.pone.0173798.
eCollection 2017.

Sharma R(1), Rosenberg A(1), Bennett ER(2), Laskowitz DT(1,)(2), Acheson
SK(3,)(4).

Mild traumatic brain injury (TBI) accounts for the vast majority of the nearly
two million brain injuries suffered in the United States each year. Mild TBI is
commonly classified as complicated (radiographic evidence of intracranial injury)
or uncomplicated (radiographically negative). Such a distinction is important
because it helps to determine the need for further neuroimaging, potential
admission, or neurosurgical intervention. Unfortunately, imaging modalities such
as computed tomography (CT) and magnetic resonance imaging (MRI) are costly and
not without some risk. The purpose of this study was to screen 87 serum
biomarkers to identify a select panel of biomarkers that would predict the
presence of intracranial injury as determined by initial brain CT. Serum was
collected from 110 patients who sustained a mild TBI within 24 hours of blood
draw. Two models were created. In the broad inclusive model, 72kDa type IV
collagenase (MMP-2), C-reactive protein (CRP), creatine kinase B type (CKBB),
fatty acid binding protein-heart (hFABP), granulocyte-macrophage
colony-stimulating factor (GM-CSF) and malondialdehyde modified low density
lipoprotein (MDA-LDL) significantly predicted injury visualized on CT, yielding
an overall c-statistic of 0.975 and a negative predictive value (NPV) of 98.6. In
the parsimonious model, MMP-2, CRP, and CKBB type significantly predicted injury
visualized on CT, yielding an overall c-statistic of 0.964 and a negative
predictive value (NPV) of 97.2. These results suggest that a serum based
biomarker panel can accurately differentiate patients with complicated mild TBI
from those with uncomplicated mild TBI. Such a panel could be useful to guide
early triage decisions, including the need for further evaluation or admission,
especially in those environments in which resources are limited. 

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