Research Reports - The potential utility of blood-derived biochemical markers as indicators of early clinical trends following severe traumatic brain injury
World Neurosurg. 2013 Jan 8
Defazio MV, Rammo RA, Robles JR, Bramlett HM, Dietrich WD, Bullock MR
OBJECTIVE: Severe traumatic brain injury (TBI) is a dynamic neuropathological
process with a substantial proportion of deaths occurring within the first
48-hours. The assessment of injury severity and prognosis are of primary concern
in the initial management of severe TBI. Supplemental testing that aids in the
stratification of patients at high risk for deterioration may significantly
improve posttraumatic management in the acute setting. METHODS: This
retrospective study assessed the utility of both single-marker and multi-marker
models as predictive indicators of acute clinical status following severe TBI.
Forty-four patients who sustained severe TBI (admission GCS ≤8) were divided into
two cohorts according to a dichotomized clinical outcome at 72-hours
post-admission: Poor Status (death or GCS ≤8) and Improved Status (GCS improved
to >8). Threshold values for clinical status prediction were calculated for serum
S-100B, MMP-9, and plasma D-Dimer, upon admission and at 24-hours post-TBI, using
ROC analysis. Performance characteristics of these single marker predictors were
compared with those derived from a multi-marker logistic regression analysis.
RESULTS: Biomarkers with the greatest predictive value for poor status at
72-hours included serum S-100B on admission, as well as plasma D-Dimer and serum
S-100B at 24-hours, for which, associations were strongly significant.
Multi-marker analysis indicated no substantial improvement in prediction accuracy
over the best single predictors during this time frame. CONCLUSION: In
conjunction with other clinical, physical, and radiologic evidence, blood-derived
biochemical markers may serve to enhance prediction of early clinical trends
following severe TBI.