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Zibetti M, Di Resta C, Banfi G, Tomaiuolo R. Value-Based Health Care Implementation: The Case Study of mTBI Biomarkers. J Pers Med 2024; 14:634. [PMID: 38929855 PMCID: PMC11204511 DOI: 10.3390/jpm14060634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 06/09/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
Traumatic brain injury is a significant global health issue, affecting approximately 69 million people annually. Early diagnosis is crucial for effective management, and biomarkers provide a promising approach to identifying traumatic brain injury in various settings. This study investigates the perceived usefulness of biomarker testing in two distinct contexts: emergency departments and sports settings. Comprehensive interviews were conducted among healthcare professionals in emergency departments and sports-related medical staff. The interviews assessed their perceptions of the diagnostic accuracy, practicality, and overall value of traumatic brain injury biomarker testing. The findings indicate that the perceived usefulness of biomarker testing is high among professionals in both settings. However, significant differences emerged in the perceived barriers to implementation, with emergency department staff citing logistical issues and sports professionals expressing cost concerns. Addressing identified barriers could enhance the adoption and effectiveness of these tests, ultimately improving patient outcomes. Future research should focus on optimizing testing protocols and reducing implementation challenges. This study aims to evaluate the implementation of mild traumatic brain injury biomarkers within the framework of value-based health care, focusing on diagnostic accuracy and patient outcomes.
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Affiliation(s)
- Martina Zibetti
- Faculty of Medicine, Università Vita-Salute San Raffaele, 20132 Milan, Italy
| | - Chiara Di Resta
- Faculty of Medicine, Università Vita-Salute San Raffaele, 20132 Milan, Italy
| | - Giuseppe Banfi
- Faculty of Medicine, Università Vita-Salute San Raffaele, 20132 Milan, Italy
- IRCCS Galeazzi-Sant’Ambrogio, 20157 Milan, Italy
| | - Rossella Tomaiuolo
- Faculty of Medicine, Università Vita-Salute San Raffaele, 20132 Milan, Italy
- IRCCS Galeazzi-Sant’Ambrogio, 20157 Milan, Italy
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2
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Calluy E, Beaudart C, Alokail MS, Al-Daghri NM, Bruyère O, Reginster JY, Cavalier E, Ladang A. Confounding factors of the expression of mTBI biomarkers, S100B, GFAP and UCH-L1 in an aging population. Clin Chem Lab Med 2024; 0:cclm-2024-0194. [PMID: 38643415 DOI: 10.1515/cclm-2024-0194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 04/02/2024] [Indexed: 04/22/2024]
Abstract
OBJECTIVES To evaluate some confounding factors that influence the concentrations of S100 calcium binding protein B (S100B), glial fibrillary acidic protein (GFAP), and ubiquitin carboxyl-terminal hydrolase L-1 (UCH-L1) in older individuals. Indeed, recent guidelines have proposed the combined use of S100B and the "GFAP-UCH-L1" mTBI test to rule out mild traumatic brain injuries (mTBI). As older adults are the most at risk of mTBI, it is particularly important to understand the confounding factors of those mTBI rule-out biomarkers in aging population. METHODS The protein S100B and the "GFAP and UCH-L1" mTBI test were measured using Liaison XL (Diasorin) and Alinity I (Abbott), respectively, in 330 and 341 individuals with non-suspected mTBI from the SarcoPhAge cohort. RESULTS S100B, GFAP and UCH-L1 were all significantly correlated with renal function whereas alcohol consumption, Geriatric Depression Score (GDS), smoking habits and anticoagulant intake were not associated with any of these three biomarkers. Body mass index (BMI) and age were associated with GFAP and UCH-L1 expression while sex and mini-mental state examination (MMSE) were only associated with GFAP. According to the manufacturer's cut-offs for mTBI rule-out, only 5.5 % of participants were positive for S100B whereas 66.9 % were positive for the "GFAP-UCH-L1" mTBI test. All positive "GFAP-UCH-L1" mTBI tests were GFAP+/UCH-L1-. Among individuals with cystatin C>1.55 mg/L, 25 % were positive for S100B while 90 % were positive for the mTBI test. CONCLUSIONS Our data show that confounding factors have different impacts on the positivity rate of the "GFAP-UCH-L1" mTBI test compared to S100B.
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Affiliation(s)
- Emma Calluy
- Clinical Chemistry Department, CHU de Liège, University of Liège, Liège, Belgium
| | - Charlotte Beaudart
- WHO Collaborating Center for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
- Clinical Pharmacology and Toxicology Research Unit (URPC), NARILIS, Department of Biomedical Sciences, Faculty of Medicine, University of Namur, Namur, Belgium
| | - Majed S Alokail
- Protein Research Chair, Biochemistry Department, 37850 College of Science, KSU , Riyadh, Kingdom of Saudi Arabia
| | - Nasser M Al-Daghri
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, 37850 College of Science, KSU , Riyadh, Kingdom of Saudi Arabia
| | - Olivier Bruyère
- WHO Collaborating Center for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
- Department of Sport and Rehabilitation Sciences, University of Liège, Liège, Belgium
| | - Jean-Yves Reginster
- WHO Collaborating Center for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
- Protein Research Chair, Biochemistry Department, 37850 College of Science, KSU , Riyadh, Kingdom of Saudi Arabia
| | - Etienne Cavalier
- Clinical Chemistry Department, CHU de Liège, University of Liège, Liège, Belgium
| | - Aurélie Ladang
- Clinical Chemistry Department, CHU de Liège, University of Liège, Liège, Belgium
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Gardner RC, Puccio AM, Korley FK, Wang KKW, Diaz-Arrastia R, Okonkwo DO, Puffer RC, Yuh EL, Yue JK, Sun X, Taylor SR, Mukherjee P, Jain S, Manley GT, Ferguson AR, Gaudette E, Shankar GC, Keene D, Madden C, Martin A, McCrea M, Merchant R, Mukherjee P, Ngwenya LB, Robertson C, Temkin N, Vassar M, Yue JK, Zafonte R. Effects of age and time since injury on traumatic brain injury blood biomarkers: a TRACK-TBI study. Brain Commun 2022; 5:fcac316. [PMID: 36642999 PMCID: PMC9832515 DOI: 10.1093/braincomms/fcac316] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/07/2022] [Accepted: 11/30/2022] [Indexed: 12/03/2022] Open
Abstract
Older adults have the highest incidence of traumatic brain injury globally. Accurate blood-based biomarkers are needed to assist with diagnosis of patients across the spectrum of age and time post-injury. Several reports have suggested lower accuracy for blood-based biomarkers in older adults, and there is a paucity of data beyond day-1 post-injury. Our aims were to investigate age-related differences in diagnostic accuracy and 2-week evolution of four leading candidate blood-based traumatic brain injury biomarkers-plasma glial fibrillary acidic protein, ubiquitin carboxy-terminal hydrolase L1, S100 calcium binding protein B and neuron-specific enolase-among participants in the 18-site prospective cohort study Transforming Research And Clinical Knowledge in Traumatic Brain Injury. Day-1 biomarker data were available for 2602 participants including 2151 patients with traumatic brain injury, 242 orthopedic trauma controls and 209 healthy controls. Participants were stratified into 3 age categories (young: 17-39 years, middle-aged: 40-64 years, older: 65-90 years). We investigated age-stratified biomarker levels and biomarker discriminative abilities across three diagnostic groups: head CT-positive/negative; traumatic brain injury/orthopedic controls; and traumatic brain injury/healthy controls. The difference in day-1 glial fibrillary acidic protein, ubiquitin carboxy-terminal hydrolase L1 and neuron-specific enolase levels across most diagnostic groups was significantly smaller for older versus younger adults, resulting in a narrower range within which a traumatic brain injury diagnosis may be discriminated in older adults. Despite this, day-1 glial fibrillary acidic protein had good to excellent performance across all age-categories for discriminating all three diagnostic groups (area under the curve 0.84-0.96; lower limit of 95% confidence intervals all >0.78). Day-1 S100 calcium-binding protein B and ubiquitin carboxy-terminal hydrolase L1 showed good discrimination of CT-positive versus negative only among adults under age 40 years within 6 hours of injury. Longitudinal blood-based biomarker data were available for 522 hospitalized patients with traumatic brain injury and 24 hospitalized orthopaedic controls. Glial fibrillary acidic protein levels maintained good to excellent discrimination across diagnostic groups until day 3 post-injury irrespective of age, until day 5 post-injury among middle-aged or younger patients and until week 2 post-injury among young patients only. In conclusion, the blood-based glial fibrillary acidic protein assay tested here has good to excellent performance across all age-categories for discriminating key traumatic brain injury diagnostic groups to at least 3 days post-injury in this trauma centre cohort. The addition of a blood-based diagnostic to the evaluation of traumatic brain injury, including geriatric traumatic brain injury, has potential to streamline diagnosis.
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Affiliation(s)
- Raquel C Gardner
- Correspondence to: Raquel C. Gardner, MD Sheba Medical Center, Derech Sheba 2 Ramat Gan, Israel 52621 E-mail:
| | - Ava M Puccio
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Frederick K Korley
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Kevin K W Wang
- Departments of Emergency Medicine, Psychiatry, and Neuroscience, McKnight Brain Institute, University of Florida, Gainesville, FL 32610, USA,Brain Rehabilitation Research Center (BRRC), Malcom Randall VA Medical Center, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd., 32608, USA
| | - Ramon Diaz-Arrastia
- Department of Neurology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - David O Okonkwo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Ross C Puffer
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA,Department of Neurological Surgery, Mayo Clinic, Rochester, MN 55901, USA
| | - Esther L Yuh
- Department of Radiology, University of California, San Francisco, San Francisco, CA 94143, USA
| | - John K Yue
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Xiaoying Sun
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA 92161, USA
| | - Sabrina R Taylor
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Pratik Mukherjee
- Department of Radiology, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Sonia Jain
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA 92161, USA
| | - Geoffrey T Manley
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94143, USA
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Jović M, Prim D, Saini E, Pfeifer ME. Towards a Point-of-Care (POC) Diagnostic Platform for the Multiplex Electrochemiluminescent (ECL) Sensing of Mild Traumatic Brain Injury (mTBI) Biomarkers. BIOSENSORS 2022; 12:172. [PMID: 35323442 PMCID: PMC8946848 DOI: 10.3390/bios12030172] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/02/2022] [Accepted: 03/07/2022] [Indexed: 06/14/2023]
Abstract
Globally, 70 million people are annually affected by TBI. A significant proportion of all TBI cases are actually mild TBI (concussion, 70-85%), which is considerably more difficult to diagnose due to the absence of apparent symptoms. Current clinical practice of diagnosing mTBI largely resides on the patients' history, clinical aspects, and CT and MRI neuroimaging observations. The latter methods are costly, time-consuming, and not amenable for decentralized or accident site measurements. As an alternative (and/or complementary), mTBI diagnostics can be performed by detection of mTBI biomarkers from patients' blood. Herein, we proposed two strategies for the detection of three mTBI-relevant biomarkers (GFAP, h-FABP, and S100β), in standard solutions and in human serum samples by using an electrochemiluminescence (ECL) immunoassay on (i) a commercial ECL platform in 96-well plate format, and (ii) a "POC-friendly" platform with disposable screen-printed carbon electrodes (SPCE) and a portable ECL reader. We further demonstrated a proof-of-concept for integrating three individually developed mTBI assays ("singleplex") into a three-plex ("multiplex") assay on a single SPCE using a spatially resolved ECL approach. The presented methodology demonstrates feasibility and a first step towards the development of a rapid POC multiplex diagnostic system for the detection of a mTBI biomarker panel on a single SPCE.
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Wijanarko F, Alifianto U, Setyono H, Arsika Ramadhana G, Sungkar AA, Saadhi I, Setiawati DA. S100β protein levels as a parameter to assess the clinical development of adult patients with mild traumatic brain injury in Dr. Moewardi Public Hospital, Surakarta. Surg Neurol Int 2021; 12:342. [PMID: 34345483 PMCID: PMC8326141 DOI: 10.25259/sni_294_2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 06/04/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Mild traumatic brain injury (mTBI) is a health problem with an increasing incidence in many developed countries. The standard for examining mTBI is a CT scan, but it is costly, is not always available in all hospitals, and carries a risk of radiation. Meanwhile, S100β is a protein component produced by central nervous system cells. This study aims to determine the presence of changes in S100β protein in adult patients with mTBI during treatment as an alternative to examination. METHODS This research is an analytic observational quantitative study with a cross-sectional study approach to investigate changes in S100β protein levels in blood serum using the ELISA method of mTBI patients in the first 3 h posttrauma (pretest) and treatment on day 1 (27 h posttrauma/posttest). The research sample consisted of 22 people. This research was conducted in the Surgery Section, Sub-Division of Neurosurgery, Dr. Moewardi Public Hospital, during September-December 2019. The data were then analyzed using a discrimination test (comparing t-test means) and a nonparametric test (Wilcoxon). RESULTS There was a significant difference in mean S100β change between the pretest and posttest treatments. The S100β examination results at posttest decreased to 0.0223 + 0.0029 μg/l or decreased S100β by 21.7% after treatment. Previously, it was known that the mean of S100β at pretest was 0.0285 + 0.0137 μg/l. CONCLUSION There was a significant change in S100β protein levels at each examination time. Changes in S100β levels that occurred were in the form of decreased levels from 3 h to 27 h posttrauma. Thus, S100β protein can be used as a parameter to assess the clinical development of adult patients with mTBI. Moreover, none of the patients with an S100β value >0.1 μg/l was found to be the cutoff value set by SNC in adult patients with mTBI for head CT scan.
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Affiliation(s)
- Ferry Wijanarko
- Department of Neurosurgery, Dr. Moewardi General Hospital, Faculty of Medicine University of Sebelas Maret, Surakarta, Indonesia
| | - Untung Alifianto
- Department of Neurosurgery, Dr. Moewardi General Hospital, Faculty of Medicine University of Sebelas Maret, Surakarta, Indonesia
| | - Hanis Setyono
- Department of Neurosurgery, Dr. Moewardi General Hospital, Faculty of Medicine University of Sebelas Maret, Surakarta, Indonesia
| | - Geizar Arsika Ramadhana
- Department of Neurosurgery, Dr. Moewardi General Hospital, Faculty of Medicine University of Sebelas Maret, Surakarta, Indonesia
| | - Affan Adib Sungkar
- Faculty of Medicine University of Sebelas Maret, Department of Neurosurgery, Dr. Moewardi General Hospital, University of Sebelas Maret Hospital, Surakarta, Indonesia
| | - Ikhdin Saadhi
- Department of Surgery, Dr. Moewardi General Hospital, Faculty of Medicine University of Sebelas Maret, Surakarta, Indonesia
| | - Dea Alberta Setiawati
- Department of Surgery, Dr. Moewardi General Hospital, Faculty of Medicine University of Sebelas Maret, Surakarta, Indonesia
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Iverson GL, Posti JP, Öhman J, Blennow K, Zetterberg H, Luoto TM. Reliability of serum S100B measurement following mild traumatic brain injury: a comparison of assay measurements from two laboratories. Brain Inj 2020; 34:1237-1244. [PMID: 32744887 DOI: 10.1080/02699052.2020.1800092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE There is enormous research and clinical interest in blood-based biomarkers of mild traumatic brain injury (MTBI) sustained in sports, daily life, or military service. We examined the reliability of a commercially available assay for S100B used on the same samples by two different laboratories separated by 2 years in time. METHODS AND PROCEDURES A cohort of 163 adult patients (head CT-scanned, n = 110) with mild head injury were enrolled from the emergency department (ED). All had Glasgow Coma Scale scores of 14 or 15 in the ED (94.4% = 15). The mean time between injury and venous blood sampling was 2.9 h (SD = 1.4; Range = 0.5-6.0 h). Serum S100B was measured at two independent centers using the same high throughput clinical assay (Elecsys S100B®; Roche Diagnostics). RESULTS The Spearman correlation between the two assays in the total sample (N = 163) was r = 0.93. A Wilcoxson Signed Ranks test indicated that the median scores for the values differed (Z = 2,082, p < .001, Cohen's d = 0.151, small effect size). The values obtained from the two laboratories were very similar for identifying traumatic intracranial abnormalities (sensitivity = 80.1% versus 85.7%). CONCLUSIONS The serum S100B results measured using the same assay in different laboratories yielded highly correlated and clinically similar, but clearly not identical, results.
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Affiliation(s)
- Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School , Boston, MA, USA.,Spaulding Rehabilitation Hospital , Charlestown, MA, USA.,Home Base, A Red Sox Foundation and Massachusetts General Hospital Program , Boston, MA, USA
| | - Jussi P Posti
- Division of Clinical Neurosciences, Department of Neurosurgery, Turku Brain Injury Centre, Turku University Hospital, and University of Turku , Turku, Finland
| | - Juha Öhman
- Department of Neurosurgery, Tampere University Hospital and University of Tampere , Tampere, Finland
| | - Kaj Blennow
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg , Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital , Mölndal, Sweden
| | - Henrik Zetterberg
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg , Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital , Mölndal, Sweden.,UK Dementia Research Institute at University College London , London, UK.,Department of Molecular Neuroscience, University College London Institute of Neurology , London, UK
| | - Teemu Miikka Luoto
- Department of Neurosurgery, Tampere University Hospital and University of Tampere , Tampere, Finland
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Oris C, Chabanne R, Durif J, Kahouadji S, Brailova M, Sapin V, Bouvier D. Measurement of S100B protein: evaluation of a new prototype on a bioMérieux Vidas® 3 analyzer. ACTA ACUST UNITED AC 2019; 57:1177-1184. [DOI: 10.1515/cclm-2018-1217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 01/18/2019] [Indexed: 01/13/2023]
Abstract
Abstract
Background
The addition of S100B protein to guidelines for the management of mild traumatic brain injury (mTBI) decreases the amount of unnecessary computed tomography (CT) scans with a significant decrease in radiation exposure and an increase in cost savings. Both DiaSorin and Roche Diagnostics have developed automated assays for S100B determination. Recently, bioMérieux developed a prototype immunoassay for serum S100B determination. For the first time, we present the evaluation of the S100B measurement using a bioMérieux Vidas® 3 analyzer.
Methods
We evaluated the matrix effects of serum and plasma, and their stability after storage at 2–8 °C, −20 °C and −80 °C. The new measurement prototype (bioMérieux) was compared with an established one (Roche Diagnostics), and a precision study was also conducted. Lastly, clinical diagnostics performance of the bioMérieux and Roche Diagnostics methods were compared for 80 patients referred to the Emergency Department for mTBI.
Results
Stability after storage at 2–8 °C, −20 °C, and −80 °C and validation of the serum matrix were demonstrated. The bioMérieux analyzer was compared to the Roche Diagnostics system, and the analytical precision was found to be efficient. Clinical diagnosis performance evaluation confirmed the predictive negative value of S100B in the management of mTBI.
Conclusions
The study’s data are useful for interpreting serum S100B results on a bioMérieux Vidas® 3 analyzer.
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