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Backus BE, Moustafa F, Skogen K, Sapin V, Rane N, Moya-Torrecilla F, Biberthaler P, Tenovuo O. Consensus paper on the assessment of adult patients with traumatic brain injury with Glasgow Coma Scale 13-15 at the emergency department: A multidisciplinary overview. Eur J Emerg Med 2024; 31:240-249. [PMID: 38744295 DOI: 10.1097/mej.0000000000001140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Traumatic brain injury (TBI) is a common reason for presenting to emergency departments (EDs). The assessment of these patients is frequently hampered by various confounders, and diagnostics is still often based on nonspecific clinical signs. Throughout Europe, there is wide variation in clinical practices, including the follow-up of those discharged from the ED. The objective is to present a practical recommendation for the assessment of adult patients with an acute TBI, focusing on milder cases not requiring in-hospital care. The aim is to advise on and harmonize practices for European settings. A multiprofessional expert panel, giving consensus recommendations based on recent scientific literature and clinical practices, is employed. The focus is on patients with a preserved consciousness (Glasgow Coma Scale 13-15) not requiring in-hospital care after ED assessment. The main results of this paper contain practical, clinically usable recommendations for acute clinical assessment, decision-making on acute head computerized tomography (CT), use of biomarkers, discharge options, and needs for follow-up, as well as a discussion of the main features and risk factors for prolonged recovery. In conclusion, this consensus paper provides a practical stepwise approach for the clinical assessment of patients with an acute TBI at the ED. Recommendations are given for the performance of acute head CT, use of brain biomarkers and disposition after ED care including careful patient information and organization of follow-up for those discharged.
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Affiliation(s)
- Barbra E Backus
- Emergency Department, Franciscus Gasthuis and Vlietland, Rotterdam
- Emergency Department, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Farès Moustafa
- Emergency Department, University Hospital Clermont Auvergne, Clermont-Ferrand, France
| | - Karoline Skogen
- Department of Radiology and Nuclear Medicine, Oslo University Hospitals, Oslo, Norway
| | - Vincent Sapin
- Biochemistry and Molecular Genetics Department, University Hospital Clermont Auvergne, Clermont-Ferrand, France
| | - Neil Rane
- Department of Neuroradiology, St Marys Hospital Major Trauma Centre, Imperial College London NHS Trust
| | - Francisco Moya-Torrecilla
- Physical Therapy Department, School of Health Sciences, University of Malaga, Spain
- International Medical Services, Vithas Xanit International Hospital, Malaga, Spain
| | - Peter Biberthaler
- Department of Trauma Surgery, Klinikum rechts der Isar Technische Universität, Munich, Germany
| | - Olli Tenovuo
- Department of Clinical Medicine, University of Turku, Turku, Finland
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Menditto VG, Rossetti G, Sampaolesi M, Buzzo M, Pomponio G. Traumatic Brain Injury in Patients under Anticoagulant Therapy: Review of Management in Emergency Department. J Clin Med 2024; 13:3669. [PMID: 38999235 PMCID: PMC11242576 DOI: 10.3390/jcm13133669] [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: 04/26/2024] [Revised: 06/15/2024] [Accepted: 06/17/2024] [Indexed: 07/14/2024] Open
Abstract
The best management of patients who suffer from traumatic brain injury (TBI) while on oral anticoagulants is one of the most disputed problems of emergency services. Indeed, guidelines, clinical decision rules, and observational studies addressing this topic are scarce and conflicting. Moreover, relevant issues such as the specific treatment (and even definition) of mild TBI, rate of delayed intracranial injury, indications for neurosurgery, and anticoagulant modulation are largely empiric. We reviewed the most recent evidence on these topics and explored other clinically relevant aspects, such as the promising role of dosing brain biomarkers, the strategies to assess the extent of anticoagulation, and the indications of reversals and tranexamic acid administration, in cases of mild TBI or as a bridge to neurosurgery. The appropriate timing of anticoagulant resumption was also discussed. Finally, we obtained an insight into the economic burden of TBI in patients on oral anticoagulants, and future directions on the management of this subpopulation of TBI patients were proposed. In this article, at the end of each section, a "take home message" is stated.
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Affiliation(s)
- Vincenzo G Menditto
- Emergency and Internal Medicine Department, Azienda Ospedaliero Universitaria delle Marche, 60126 Ancona, Italy
| | - Giulia Rossetti
- Internal Medicine, Santa Croce Hospital AST1 Pesaro Urbino, 61032 Fano, Italy
| | - Mattia Sampaolesi
- Emergency and Internal Medicine Department, Azienda Ospedaliero Universitaria delle Marche, 60126 Ancona, Italy
| | - Marta Buzzo
- Emergency and Internal Medicine Department, Azienda Ospedaliero Universitaria delle Marche, 60126 Ancona, Italy
| | - Giovanni Pomponio
- Clinica Medica, Azienda Ospedaliero Universitaria delle Marche, 60126 Ancona, Italy
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Tiantian W, Yonghui W, Junbo L. Antibody-labeled gold nanoparticle based resonance Rayleigh scattering detection of S100B. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2024; 16:3074-3080. [PMID: 38683678 DOI: 10.1039/d4ay00335g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Traumatic brain injury (TBI) is a sudden brain injury due to an external force that causes a large number of deaths and permanent disabilities every year. S100B has been recognized as a potential objective quantitative biomarker for screening the prognosis of TBI and severe head injury. In this article, an anti-S100B monoclonal antibody was immobilized on cysteamine (Cy) functionalized gold nanoparticles (AuNPs) by EDC-NHS chemistry, which enabled S100B resonance Rayleigh scattering (RRS) detection based on antibody-labeled gold nanoparticles. The prepared conjugates were characterized by ultraviolet-visible spectroscopy (UV-vis), transmission electron microscopy (TEM), Fourier transform infrared spectroscopy (FTIR), dynamic light scattering (DLS) and sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). Based on the specific binding of the antibody and antigen, the RRS intensities at 381 nm and 541 nm wavelengths were significantly enhanced, and thus a dual wavelength overlapping resonance Rayleigh scattering (DWO-RRS) method was established. The scattering intensity of the two overlapping peaks was proportional to the concentration of S100B in the range of 0.05-4.5 ng mL-1 with a detection limit of 0.002 ng mL-1. The proposed DWO-RRS method is time-saving, simple, sensitive, and can be used to determine the concentration of S100B in human serum with satisfactory results, which has a promising application in the early diagnosis of TBI.
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Affiliation(s)
- Wang Tiantian
- School of Basic Medicine, Shanxi University of Traditional Chinese Medicine, Jinzhong, Shanxi, 030619, China.
| | - Wang Yonghui
- School of Basic Medicine, Shanxi University of Traditional Chinese Medicine, Jinzhong, Shanxi, 030619, China.
| | - Li Junbo
- School of Pharmacy, Changzhi Medical College, Changzhi, 046000, China.
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Oris C, Bouillon-Minois JB, Kahouadji S, Pereira B, Dhaiby G, Defrance VB, Durif J, Schmidt J, Moustafa F, Bouvier D, Sapin V. S100B vs. "GFAP and UCH-L1" assays in the management of mTBI patients. Clin Chem Lab Med 2024; 62:891-899. [PMID: 38033294 DOI: 10.1515/cclm-2023-1238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/20/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVES To compare for the first time the performance of "GFAP and UCH-L1" vs. S100B in a cohort of patients managed for mild traumatic brain injury (mTBI) according to actualized French guidelines. METHODS A prospective study was recently carried at the Emergency Department of Clermont-Ferrand University Hospital in France. Patients with mTBI presenting a medium risk of complications were enrolled. Blood S100B and "GFAP and UCHL-1" were sampled and measured according to French guidelines. S100B was measured in patients with samples within 3 h of trauma (Cobas®, Roche Diagnostics), while GFAP and UCHL-1 were measured in all patients (samples <3 h and 3-12 h) using another automated assay (i-STAT® Alinity, Abbott). RESULTS For sampling <3 h, serum S100B correctly identifies intracranial lesions with a specificity of 25.7 % (95 % CI; 19.5-32.6 %), a sensitivity of 100 % (95 % CI; 66.4-100 %), and a negative predictive value of 100 % (95 % CI; 92.5-100 %). For sampling <12 h, plasma "GFAP and UCH-L1" levels correctly identify intracranial lesions with a specificity of 31.7 % (95 % CI; 25.7-38.2 %), a sensitivity of 100 % (95 % CI; 73.5-100 %), and a negative predictive value of 100 % (95 % CI; 95-100 %). Comparison of specificities (25.7 vs. 31.7 %) did not reveal a statistically significant difference (p=0.16). CONCLUSIONS We highlight the usefulness of measuring plasma "GFAP and UCH-L1" levels to target mTBI patients (sampling within 12 h post-injury) and optimize the reduction of CT scans.
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Affiliation(s)
- Charlotte Oris
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
- Université Clermont Auvergne, CNRS, INSERM, GReD, Clermont-Ferrand, France
| | | | - Samy Kahouadji
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
- Université Clermont Auvergne, CNRS, INSERM, GReD, Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics Unit (DRCI), CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Gabriel Dhaiby
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Julie Durif
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Jeannot Schmidt
- Adult Emergency Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Farès Moustafa
- Adult Emergency Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Damien Bouvier
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
- Université Clermont Auvergne, CNRS, INSERM, GReD, Clermont-Ferrand, France
| | - Vincent Sapin
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
- Université Clermont Auvergne, CNRS, INSERM, GReD, Clermont-Ferrand, France
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Oris C, Kahouadji S, Bouvier D, Sapin V. Blood Biomarkers for the Management of Mild Traumatic Brain Injury in Clinical Practice. Clin Chem 2024:hvae049. [PMID: 38656380 DOI: 10.1093/clinchem/hvae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/15/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Despite the use of validated guidelines in the management of mild traumatic brain injury (mTBI), processes to limit unnecessary brain scans are still not sufficient and need to be improved. The use of blood biomarkers represents a relevant adjunct to identify patients at risk for intracranial injury requiring computed tomography (CT) scan. CONTENT Biomarkers currently recommended in the management of mTBI in adults and children are discussed in this review. Protein S100 beta (S100B) is the best-documented blood biomarker due to its validation in large observational and interventional studies. Glial fibrillary acidic protein (GFAP) and ubiquitin carboxyterminal hydrolase L-1 (UCH-L1) have also recently demonstrated their usefulness in patients with mTBI. Preanalytical, analytical, and postanalytical performance are presented to aid in their interpretation in clinical practice. Finally, new perspectives on biomarkers and mTBI are discussed. SUMMARY In adults, the inclusion of S100B in Scandinavian and French guidelines has reduced the need for CT scans by at least 30%. S100B has significant potential as a diagnostic biomarker, but limitations include its rapid half-life, which requires blood collection within 3 h of trauma, and its lack of neurospecificity. In 2018, the FDA approved the use of combined determination of GFAP and UCH-L1 to aid in the assessment of mTBI. Since 2022, new French guidelines also recommend the determination of GFAP and UCH-L1 in order to target a larger number of patients (sampling within 12 h post-injury) and optimize the reduction of CT scans. In the future, new cut-offs related to age and promising new biomarkers are expected for both diagnostic and prognostic applications.
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Affiliation(s)
- Charlotte Oris
- Biochemistry and Molecular Genetics Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
- CNRS, INSERM, iGReD, Clermont Auvergne University, Clermont-Ferrand, France
| | - Samy Kahouadji
- Biochemistry and Molecular Genetics Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
- CNRS, INSERM, iGReD, Clermont Auvergne University, Clermont-Ferrand, France
| | - Damien Bouvier
- Biochemistry and Molecular Genetics Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
- CNRS, INSERM, iGReD, Clermont Auvergne University, Clermont-Ferrand, France
| | - Vincent Sapin
- Biochemistry and Molecular Genetics Department, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
- CNRS, INSERM, iGReD, Clermont Auvergne University, Clermont-Ferrand, France
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Oris C, Khatib-Chahidi C, Pereira B, Bailly Defrance V, Bouvier D, Sapin V. Comparison of GFAP and UCH-L1 Measurements Using Two Automated Immunoassays (i-STAT ® and Alinity ®) for the Management of Patients with Mild Traumatic Brain Injury: Preliminary Results from a French Single-Center Approach. Int J Mol Sci 2024; 25:4539. [PMID: 38674124 PMCID: PMC11049915 DOI: 10.3390/ijms25084539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
The measurement of blood glial fibrillary acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1) may assist in the management of mild traumatic brain injury (mTBI). This study aims to compare GFAP and UCH-L1 values measured using a handheld device with those measured using a core laboratory platform. We enrolled 230 mTBI patients at intermediate risk of complications. Following French guidelines, a negative S100B value permits the patient to be discharged without a computed tomography scan. Plasma GFAP and UCH-L1 levels were retrospectively measured using i-STAT® and Alinity® i analyzers in patients managed within 12 h post-trauma. Our analysis indicates a strong correlation of biomarker measurements between the two analyzers. Cohen's kappa coefficients and Lin's concordance coefficients were both ≥0.7, while Spearman's correlation coefficient was 0.94 for GFAP and 0.90 for UCH-L1. Additionally, the diagnostic performance in identifying an intracranial lesion was not significantly different between the two analyzers, with a sensitivity of 100% and specificity of approximately 30%. GFAP and UCH-L1 levels measured using Abbott's i-STAT® and Alinity® i platform assays are highly correlated both analytically and clinically in a cohort of 230 patients managed for mTBI according to French guidelines.
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Affiliation(s)
- Charlotte Oris
- Biochemistry and Molecular Genetics Department, University Hospital, 63000 Clermont-Ferrand, France; (C.O.); (C.K.-C.); (V.B.D.); (D.B.)
| | - Clara Khatib-Chahidi
- Biochemistry and Molecular Genetics Department, University Hospital, 63000 Clermont-Ferrand, France; (C.O.); (C.K.-C.); (V.B.D.); (D.B.)
| | - Bruno Pereira
- Clinical Research and Innovation Department, University Hospital, 63000 Clermont-Ferrand, France;
| | - Valentin Bailly Defrance
- Biochemistry and Molecular Genetics Department, University Hospital, 63000 Clermont-Ferrand, France; (C.O.); (C.K.-C.); (V.B.D.); (D.B.)
| | - Damien Bouvier
- Biochemistry and Molecular Genetics Department, University Hospital, 63000 Clermont-Ferrand, France; (C.O.); (C.K.-C.); (V.B.D.); (D.B.)
- Institute “Genetic, Reproduction and Development”, UMR INSERM 1103 CNRS 6293, Université Clermont Auvergne, 63001 Clermont-Ferrand, France
| | - Vincent Sapin
- Biochemistry and Molecular Genetics Department, University Hospital, 63000 Clermont-Ferrand, France; (C.O.); (C.K.-C.); (V.B.D.); (D.B.)
- Institute “Genetic, Reproduction and Development”, UMR INSERM 1103 CNRS 6293, Université Clermont Auvergne, 63001 Clermont-Ferrand, France
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Bouvier D, Cantais A, Laspougeas A, Lorton F, Plenier Y, Cottier M, Fournier P, Tran A, Moreau E, Durif J, Sarret C, Mourgues C, Sturtz F, Oudart JB, Raffort J, Gonzalo P, Cristol JP, Masson D, Pereira B, Sapin V. Serum S100B Level in the Management of Pediatric Minor Head Trauma: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e242366. [PMID: 38502126 PMCID: PMC10951739 DOI: 10.1001/jamanetworkopen.2024.2366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/23/2024] [Indexed: 03/20/2024] Open
Abstract
Importance Minor head trauma (HT) is one of the most common causes of hospitalization in children. A diagnostic test could prevent unnecessary hospitalizations and cranial computed tomographic (CCT) scans. Objective To evaluate the effectiveness of serum S100B values in reducing exposure to CCT scans and in-hospital observation in children with minor HT. Design, Setting, and Participants This multicenter, unblinded, prospective, interventional randomized clinical trial used a stepped-wedge cluster design to compare S100B biomonitoring and control groups at 11 centers in France. Participants included children and adolescents 16 years or younger (hereinafter referred to as children) admitted to the emergency department with minor HT. The enrollment period was November 1, 2016, to October 31, 2021, with a follow-up period of 1 month for each patient. Data were analyzed from March 7 to May 29, 2023, based on the modified intention-to-treat and per protocol populations. Interventions Children in the control group had CCT scans or were hospitalized according to current recommendations. In the S100B biomonitoring group, blood sampling took place within 3 hours after minor HT, and management depended on serum S100B protein levels. If the S100B level was within the reference range according to age, the children were discharged from the emergency department. Otherwise, children were treated as in the control group. Main Outcomes and Measures Proportion of CCT scans performed (absence or presence of CCT scan for each patient) in the 48 hours following minor HT. Results A total of 2078 children were included: 926 in the control group and 1152 in the S100B biomonitoring group (1235 [59.4%] boys; median age, 3.2 [IQR, 1.0-8.5] years). Cranial CT scans were performed in 299 children (32.3%) in the control group and 112 (9.7%) in the S100B biomonitoring group. This difference of 23% (95% CI, 19%-26%) was not statistically significant (P = .44) due to an intraclass correlation coefficient of 0.32. A statistically significant 50% reduction in hospitalizations (95% CI, 47%-53%) was observed in the S100B biomonitoring group (479 [41.6%] vs 849 [91.7%]; P < .001). Conclusions and Relevance In this randomized clinical trial of effectiveness of the serum S100B level in the management of pediatric minor HT, S100B biomonitoring yielded a reduction in the number of CCT scans and in-hospital observation when measured in accordance with the conditions defined by a clinical decision algorithm. Trial Registration ClinicalTrials.gov Identifier: NCT02819778.
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Affiliation(s)
- Damien Bouvier
- Department of Biochemistry and Molecular Genetics, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Université Clermont Auvergne, Centre National de la Recherche Scientifique (CNRS), Institut National de la Santé et de la Recherche Médicale (INSERM), Génétique, Reproduction et Développement, Clermont-Ferrand, France
| | - Aymeric Cantais
- Department of Pediatrics, CHU Saint-Etienne, Saint-Etienne, France
| | | | - Fleur Lorton
- Pediatric Emergency Department, Nantes Université, CHU Nantes, INSERM, Centre d’Investigation Clinique 1413, Nantes, France
| | | | - Maria Cottier
- Department of Pediatrics, CHU Montpellier, Montpellier, France
| | | | - Antoine Tran
- Department of Pediatrics, CHU Nice, Nice, France
| | - Emilie Moreau
- Department of Pediatrics, Assistance Publique–Hôpitaux de Marseille, Marseille, France
| | - Julie Durif
- Department of Biochemistry and Molecular Genetics, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Catherine Sarret
- Department of Pediatrics, CHU Clermont-Ferrand, Université Clermont Auvergne, CNRS, SIGMA, Thérapies Guidées par l’Image, Clermont-Ferrand, France
| | - Charline Mourgues
- Biostatistics Unit (Délégation à la Recherche Clinique et à l’Innovation), CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Franck Sturtz
- Department of Biochemistry, CHU Limoges, Limoges, France
| | - Jean-Baptiste Oudart
- Faculté de Médecine, Université de Reims Champagne-Ardenne, Matrice Extracellulaire et Dynamique Cellulaire Unit, UMR CNRS 7369, Reims, France
| | | | - Philippe Gonzalo
- Department of Biochemistry and Pharmacology, CHU Saint-Etienne, Saint-Etienne, France
| | | | - Damien Masson
- Department of Biochemistry, CHU Nantes, Nantes, France
| | - Bruno Pereira
- Biostatistics Unit (Délégation à la Recherche Clinique et à l’Innovation), CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Vincent Sapin
- Department of Biochemistry and Molecular Genetics, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Université Clermont Auvergne, Centre National de la Recherche Scientifique (CNRS), Institut National de la Santé et de la Recherche Médicale (INSERM), Génétique, Reproduction et Développement, Clermont-Ferrand, France
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Santing JAL, Hopman JH, Verheul RJ, van der Naalt J, van den Brand CL, Jellema K. Clinical value of S100B in detecting intracranial injury in elderly patients with mild traumatic brain injury. Injury 2024; 55:111313. [PMID: 38219558 DOI: 10.1016/j.injury.2024.111313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/21/2023] [Accepted: 01/02/2024] [Indexed: 01/16/2024]
Abstract
OBJECTIVE The biomarker S100B is a sensitive biomarker to detect traumatic intracranial injury in patients mild traumatic brain injury (mTBI). Higher blood values of S100B, resulting in lower specificity and decreased head computed tomography (CT) reduction has been regarded as one of shortcomings in patients over 65 years of age. The purpose of this study was to assess the accuracy of plasma S100B to detect intracranial injury in elderly patients with mTBI. METHODS A posthoc analysis was performed of a larger prospective cohort study. Previous recorded patient variables and plasma values of S100B from patients with mTBI who presented to the Emergency Department (ED) within 6 h of injury, underwent a head CT and had a blood sample drawn as part of their routine clinical care, were partitioned at 65 years of age. Sensitivity, specificity, negative predictive value, and positive predictive value of plasma S100B for predicting traumatic intracranial lesions on head CT, with a cut-off set at 0.105 μg/L, were calculated. Results were compared with data from an additional systematic review on the accuracy of S100B to detect intracranial injury in elderly patients with mTBI. RESULTS Data of 240 patients (48.4 %) of 65 years or older were analyzed. Sensitivity and NPV of S100B were 89 % and 86 % respectively, which is lower than among younger patients (both 97 %). The specificity decreased stepwise with older age: 22 %, 18 %, and 5 % for the age groups 65-74, 75-84, and ≥ 85 years old, respectively. The meta-analysis comprised 4 studies and the current study with data from 2166 patients. Pooled data estimated the sensitivity of s100B as 97.4 % (95 % CI 83.3-100 %) and specificity as 17.3 % (95 % CI 9.5-29.3 %) to detect intracranial injury in elderly patients with mTBI. CONCLUSION The biomarker S100B at the routine threshold has a limited clinical value in the management of elderly mTBI patients mainly due to a poor specificity leading to only a small decrease in head CTs. Alternate cut-off values and combining several plasma biomarkers with clinical variables may be useful strategies to increase the accuracy of S100B in (subgroups of) elderly mTBI patients.
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Affiliation(s)
| | - Joella H Hopman
- Department of Emergency Medicine, Haaglanden Medical Center, The Hague, The Netherlands
| | - Rolf J Verheul
- Department of Clinical Chemistry and Laboratory Medicine, Haaglanden Medical Center, The Hague, The Netherlands
| | - Joukje van der Naalt
- Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands
| | - Crispijn L van den Brand
- Department of Emergency Medicine, Haaglanden Medical Center, The Hague, The Netherlands; Department of Emergency Medicine, Erasmus Medical Center, The Netherlands
| | - Korné Jellema
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
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9
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Wania R, Lampart A, Niedermeier S, Stahl R, Trumm C, Reidler P, Kammerlander C, Böcker W, Klein M, Pedersen V. Diagnostic value of protein S100b as predictor of traumatic intracranial haemorrhage in elderly adults with low-energy falls: results from a retrospective observational study. Eur J Trauma Emerg Surg 2024; 50:205-213. [PMID: 37442831 PMCID: PMC10924004 DOI: 10.1007/s00068-023-02324-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 07/01/2023] [Indexed: 07/15/2023]
Abstract
PURPOSE The objectives of this study were to analyse the clinical value of protein S100b (S100b) in association with clinical findings and anticoagulation therapy in predicting traumatic intracranial haemorrhage (tICH) and unfavourable outcomes in elderly individuals with low-energy falls (LEF). METHODS We conducted a retrospective study in the emergency department (ED) of the LMU University Hospital, Munich by consecutively including all patients aged ≥ 65 years presenting to the ED following a LEF between September 2014 and December 2016 and receiving an emergency cranial computed tomography (cCT) examination. Primary endpoint was the prevalence of tICH. Multivariate logistic regression models and receiver operating characteristics were used to measure the association between clinical findings, anticoagulation therapy and S100b and tICH. RESULTS We included 2687 patients, median age was 81 years (60.4% women). Prevalence of tICH was 6.7% (180/2687) and in-hospital mortality was 6.1% (11/180). Skull fractures were highly associated with tICH (odds ratio OR 46.3; 95% confidence interval CI 19.3-123.8, p < 0.001). Neither anticoagulation therapy nor S100b values were significantly associated with tICH (OR 1.14; 95% CI 0.71-1.86; OR 1.08; 95% CI 0.90-1.25, respectively). Sensitivity of S100b (cut-off: 0.1 ng/ml) was 91.6% (CI 95% 85.1-95.9), specificity was 17.8% (CI 95% 16-19.6), and the area under the curve value was 0.59 (95% CI 0.54 - 0.64) for predicting tICH. CONCLUSION In conclusion, under real ED conditions, neither clinical findings nor protein S100b concentrations or presence of anticoagulation therapy was sufficient to decide with certainty whether a cCT scan can be bypassed in elderly patients with LEF. Further prospective validation is required.
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Affiliation(s)
- Rebecca Wania
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr 15., 81377, Munich, Germany
| | - Alina Lampart
- Department of Medicine, Kantonsspital Lucerne, Spitalstrasse, 6000, Lucerne, Switzerland
| | - Sandra Niedermeier
- Department of Anaesthesiology and Intensive Care Medicine, ISAR Klinikum, Sonnenstr. 24-26, 80331, Munich, Germany
| | - Robert Stahl
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Christoph Trumm
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Paul Reidler
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Christian Kammerlander
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr 15., 81377, Munich, Germany
- Trauma Hospital Styria, Goestinger Straße 24, 8020, Graz, Austria
| | - Wolfgang Böcker
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr 15., 81377, Munich, Germany
| | - Matthias Klein
- Department of Neurology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Emergency Department, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Vera Pedersen
- Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr 15., 81377, Munich, Germany.
- Emergency Department, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
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10
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Trivedi D, Forssten MP, Cao Y, Ismail AM, Czeiter E, Amrein K, Kobeissy F, Wang KKW, DeSoucy E, Buki A, Mohseni S. Screening Performance of S100 Calcium-Binding Protein B, Glial Fibrillary Acidic Protein, and Ubiquitin C-Terminal Hydrolase L1 for Intracranial Injury Within Six Hours of Injury and Beyond. J Neurotrauma 2024; 41:349-358. [PMID: 38115670 DOI: 10.1089/neu.2023.0322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
The Scandinavian NeuroTrauma Committee (SNC) guidelines recommend S100 calcium-binding protein B (S100B) as a screening tool for early detection of Traumatic brain injury (TBI) in patients presenting with an initial Glasgow Coma Scale (GCS) of 14-15. The objective of the current study was to compare S100B's diagnostic performance within the recommended 6-h window after injury, compared with glial fibrillary acidic protein (GFAP) and UCH-L1. The secondary outcome of interest was the ability of these biomarkers in detecting traumatic intracranial pathology beyond the 6-h mark. The Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) core database (2014-2017) was queried for data pertaining to all TBI patients with an initial GCS of 14-15 who had a blood sample taken within 6 h of injury in which the levels of S100B, GFAP, and UCH-L1 were measured. As a subgroup analysis, data involving patients with blood samples taken within 6-9 h and 9-12 h were analyzed separately for diagnostic ability. The diagnostic ability of these biomarkers for detecting any intracranial injury was evaluated based on the area under the receiver operating characteristic curve (AUC). Each biomarker's sensitivity, specificity, and accuracy were also reported at the cutoff that maximized Youden's index. A total of 531 TBI patients with GCS 14-15 on admission had a blood sample taken within 6 h, of whom 24.9% (n = 132) had radiologically confirmed intracranial injury. The AUCs of GFAP (0.86, 95% confidence interval [CI]: 0.82-0.90) and UCH-L1 (0.81, 95% CI: 0.76-0.85) were statistically significantly higher than that of S100B (0.74, 95% CI: 0.69-0.79) during this time. There was no statistically significant difference in the predictive ability of S100B when sampled within 6 h, 6-9 h, and 9-12 h of injury, as the p values were >0.05 when comparing the AUCs. Overlapping AUC 95% CI suggests no benefit of a combined GFAP and UCH-L1 screening tool over GFAP during the time periods studied [0.87 (0.83-0.90) vs. 0.86 (0.82-0.90) when sampled within 6 h of injury, 0.83 (0.78-0.88) vs. 0.83 (0.78-0.89) within 6 to 9 h and 0.81 (0.73-0.88) vs. 0.79 (0.72-0.87) within 9-12 h]. Targeted analysis of the CENTER-TBI core database, with focus on the patient category for which biomarker testing is recommended by the SNC guidelines, revealed that GFAP and UCH-L1 perform superior to S100B in predicting CT-positive intracranial lesions within 6 h of injury. GFAP continued to exhibit superior predictive ability to S100B during the time periods studied. S100B displayed relatively unaltered screening performance beyond the diagnostic timeline provided by SNC guidelines. These findings suggest the need for a reevaluation of the current SNC TBI guidelines.
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Affiliation(s)
- Dhanisha Trivedi
- Department of Neurosurgery, Orebro University Hospital, Orebro, Sweden
- School of Medical Sciences , Orebro University Hospital, Orebro, Sweden
| | | | - Yang Cao
- Clinical Epidemiology and Biostatistics, Orebro University Hospital, Orebro, Sweden
| | | | - Endre Czeiter
- Department of Neurosurgery, University of Pecs, Pecs, Hungary
- Neurotrauma Research Group, Szentágothai Research Center, University of Pecs, Pecs, Hungary
- ELKH-PTE Clinical Neuroscience MR Research Group, University of Pecs, Pecs, Hungary
| | - Krisztina Amrein
- Department of Neurosurgery, University of Pecs, Pecs, Hungary
- Neurotrauma Research Group, Szentágothai Research Center, University of Pecs, Pecs, Hungary
- ELKH-PTE Clinical Neuroscience MR Research Group, University of Pecs, Pecs, Hungary
| | - Firas Kobeissy
- Center for Neurotrauma, Multiomics, and Biomarkers, Department of Neurobiology, Neuroscience Institute, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Kevin K W Wang
- Center for Neurotrauma, Multiomics, and Biomarkers, Department of Neurobiology, Neuroscience Institute, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Erik DeSoucy
- Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Sheikh Shakhbout Medical City-Mayo Clinic, Abu Dhabi, United Arab Emirates
| | - Andras Buki
- Department of Neurosurgery, Orebro University Hospital, Orebro, Sweden
- School of Medical Sciences , Orebro University Hospital, Orebro, Sweden
| | - Shahin Mohseni
- School of Medical Sciences , Orebro University Hospital, Orebro, Sweden
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11
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Kobeissy F, Arja RD, Munoz JC, Shear DA, Gilsdorf J, Zhu J, Yadikar H, Haskins W, Tyndall JA, Wang KK. The game changer: UCH-L1 and GFAP-based blood test as the first marketed in vitro diagnostic test for mild traumatic brain injury. Expert Rev Mol Diagn 2024; 24:67-77. [PMID: 38275158 DOI: 10.1080/14737159.2024.2306876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 12/15/2023] [Indexed: 01/27/2024]
Abstract
INTRODUCTION Major organ-based in vitro diagnostic (IVD) tests like ALT/AST for the liver and cardiac troponins for the heart are established, but an approved IVD blood test for the brain has been missing, highlighting a gap in medical diagnostics. AREAS COVERED In response to this need, Abbott Diagnostics secured FDA clearance in 2021 for the i-STAT Alinity™, a point-of-care plasma blood test for mild traumatic brain injury (TBI). BioMerieux VIDAS, also approved in Europe, utilizes two brain-derived protein biomarkers: neuronal ubiquitin C-terminal hydrolase-L1 (UCH-L1) and glial fibrillary acidic protein (GFAP). These biomarkers, which are typically present in minimal amounts in healthy individuals, are instrumental in diagnosing mild TBI with potential brain lesions. The study explores how UCH-L1 and GFAP levels increase significantly in the bloodstream following traumatic brain injury, aiding in early and accurate diagnosis. EXPERT OPINION The introduction of the i-STAT Alinity™ and the Biomerieux VIDAS TBI blood tests mark a groundbreaking development in TBI diagnosis. It paves the way for the integration of TBI biomarker tools into clinical practice and therapeutic trials, enhancing the precision medicine approach by generating valuable data. This advancement is a critical step in addressing the long-standing gap in brain-related diagnostics and promises to revolutionize the management and treatment of mild TBI.
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Affiliation(s)
- Firas Kobeissy
- Program for Neurotrauma, Neuroproteomics & Biomarker Research, Neorobiology, Morehouse School of Medicine, Atlanta, GA, USA
| | - Rawad Daniel Arja
- Program for Neurotrauma, Neuroproteomics & Biomarker Research, Neorobiology, Morehouse School of Medicine, Atlanta, GA, USA
| | - Jennifer C Munoz
- Department of Pediatric Critical Care, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Deborah A Shear
- Brain Trauma Neuroprotection & Neurorestoration (BTNN) Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Janice Gilsdorf
- Brain Trauma Neuroprotection & Neurorestoration (BTNN) Branch, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Jiepei Zhu
- Program for Neurotrauma, Neuroproteomics & Biomarker Research, Neorobiology, Morehouse School of Medicine, Atlanta, GA, USA
| | - Hamad Yadikar
- Program for Neurotrauma, Neuroproteomics & Biomarker Research, Neorobiology, Morehouse School of Medicine, Atlanta, GA, USA
- Department of Biological Sciences, Kuwait University, Safat, Kuwait
| | | | | | - Kevin K Wang
- Program for Neurotrauma, Neuroproteomics & Biomarker Research, Neorobiology, Morehouse School of Medicine, Atlanta, GA, USA
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12
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Schimmel S, El Sayed B, Lockard G, Gordon J, Young I, D’Egidio F, Lee JY, Rodriguez T, Borlongan CV. Identifying the Target Traumatic Brain Injury Population for Hyperbaric Oxygen Therapy. Int J Mol Sci 2023; 24:14612. [PMID: 37834059 PMCID: PMC10572450 DOI: 10.3390/ijms241914612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
Traumatic brain injury (TBI) results from direct penetrating and indirect non-penetrating forces that alters brain functions, affecting millions of individuals annually. Primary injury following TBI is exacerbated by secondary brain injury; foremost is the deleterious inflammatory response. One therapeutic intervention being increasingly explored for TBI is hyperbaric oxygen therapy (HBOT), which is already approved clinically for treating open wounds. HBOT consists of 100% oxygen administration, usually between 1.5 and 3 atm and has been found to increase brain oxygenation levels after hypoxia in addition to decreasing levels of inflammation, apoptosis, intracranial pressure, and edema, reducing subsequent secondary injury. The following review examines recent preclinical and clinical studies on HBOT in the context of TBI with a focus on contributing mechanisms and clinical potential. Several preclinical studies have identified pathways, such as TLR4/NF-kB, that are affected by HBOT and contribute to its therapeutic effect. Thus far, the mechanisms mediating HBOT treatment have yet to be fully elucidated and are of interest to researchers. Nonetheless, multiple clinical studies presented in this review have examined the safety of HBOT and demonstrated the improved neurological function of TBI patients after HBOT, deeming it a promising avenue for treatment.
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Affiliation(s)
- Samantha Schimmel
- Morsani College of Medicine, University of South Florida, 560 Channelside Dr., Tampa, FL 33602, USA; (S.S.); (B.E.S.); (G.L.); (J.G.)
| | - Bassel El Sayed
- Morsani College of Medicine, University of South Florida, 560 Channelside Dr., Tampa, FL 33602, USA; (S.S.); (B.E.S.); (G.L.); (J.G.)
| | - Gavin Lockard
- Morsani College of Medicine, University of South Florida, 560 Channelside Dr., Tampa, FL 33602, USA; (S.S.); (B.E.S.); (G.L.); (J.G.)
| | - Jonah Gordon
- Morsani College of Medicine, University of South Florida, 560 Channelside Dr., Tampa, FL 33602, USA; (S.S.); (B.E.S.); (G.L.); (J.G.)
| | | | - Francesco D’Egidio
- Center of Excellence for Aging and Brain Repair, Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, 12901 Bruce B Downs Blvd, Tampa, FL 33612, USA; (F.D.); (J.Y.L.)
| | - Jea Young Lee
- Center of Excellence for Aging and Brain Repair, Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, 12901 Bruce B Downs Blvd, Tampa, FL 33612, USA; (F.D.); (J.Y.L.)
| | - Thomas Rodriguez
- School of Medicine, Loma Linda University, 11175 Campus St., Loma Linda, CA 92350, USA;
| | - Cesar V. Borlongan
- Center of Excellence for Aging and Brain Repair, Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, 12901 Bruce B Downs Blvd, Tampa, FL 33612, USA; (F.D.); (J.Y.L.)
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13
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Zhang H, Gopinath SC, Hu Y. Spinal cord injury immunosensor: Sensitive detection of S100β on interdigitated electrode sensor. Heliyon 2023; 9:e19304. [PMID: 37662784 PMCID: PMC10471997 DOI: 10.1016/j.heliyon.2023.e19304] [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: 11/22/2022] [Revised: 07/26/2023] [Accepted: 08/17/2023] [Indexed: 09/05/2023] Open
Abstract
A spinal cord injury is damage to the nerves and cells that receive and provide a signal from the brain to the rest of the body. Spinal injury causes changes in movement, sensation, and strength, affect the body functions near the injury site, and may lead to paralysis. S100β was found as a suitable biomarker for identifying spinal cord injury and its causing problem. Herein, S100β immunoassay was developed on interdigitated electrode sensor to diagnose spinal cord injury. For effective anti-S100β antibody immobilization, the antibody was premixed with 3-Aminopropyl)triethoxsilane and then attached to the hydroxylated interdigitated electrode surface. This method of antibody immobilization enhanced the antibody attachment two-times than the method without premix. Antibody-attached surfaces increased current responses as S100 concentrations increased, and the limit of detection was seen to be 1 pg/mL on the linearity until 3000 pg/mL at an R2 value of 0.9907 [y = 7x - 6.4667]. Further, biofouling experiments with glial fibrillary acidic protein and γ-aminobutyric acid failed to enhance the current response, indicating the specific detection of S100β. This immunoassay identifies S100β at its lower level and helps to diagnose spinal cord injury and its related problem.
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Affiliation(s)
- Hao Zhang
- Department of Surgery, Hospital of Northwestern Polytechnical University 127 Youyi West Road, Beilin District, Xi 'an 710072, China
| | - Subash C.B. Gopinath
- Faculty of Chemical Engineering & Technology, Universiti Malaysia Perlis (UniMAP), 02600 Arau, Perlis, Malaysia
- Institute of Nano Electronic Engineering, Universiti Malaysia Perlis (UniMAP), 01000 Kangar, Perlis, Malaysia
- Micro System Technology, Centre of Excellence (CoE), Universiti Malaysia Perlis (UniMAP), Pauh Campus, 02600 Arau, Perlis, Malaysia
- Department of Computer Science and Engineering, Faculty of Science and Information Technology, Daffodil International University, Daffodil Smart City, Birulia, Savar, Dhaka 1216, Bangladesh
| | - Yajun Hu
- Department of Surgery, Weinan Heyang Hospital, Weinan, 714000, China
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14
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Abboud T, Rohde V, Mielke D. Mini review: Current status and perspective of S100B protein as a biomarker in daily clinical practice for diagnosis and prognosticating of clinical outcome in patients with neurological diseases with focus on acute brain injury. BMC Neurosci 2023; 24:38. [PMID: 37474905 PMCID: PMC10360330 DOI: 10.1186/s12868-023-00807-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/13/2023] [Indexed: 07/22/2023] Open
Abstract
Prognosticating the clinical outcome of neurological diseases is essential to guide treatment and facilitate decision-making. It usually depends on clinical and radiological findings. Biomarkers have been suggested to support this process, as they are deemed objective measures and can express the extent of tissue damage or reflect the degree of inflammation. Some of them are specific, and some are not. Few of them, however, reached the stage of daily application in clinical practice. This mini review covers available applications of the S100B protein in prognosticating clinical outcome in patients with various neurological disorders, particularly in those with traumatic brain injury, spontaneous subarachnoid hemorrhage and ischemic stroke. The aim is to provide an understandable picture of the clinical use of the S100B protein and give a brief overview of the current limitations that require future solutions.
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Affiliation(s)
- Tammam Abboud
- Department of Neurosurgery, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
| | - Veit Rohde
- Department of Neurosurgery, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Dorothee Mielke
- Department of Neurosurgery, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
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15
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Oris C, Kahouadji S, Durif J, Bouvier D, Sapin V. S100B, Actor and Biomarker of Mild Traumatic Brain Injury. Int J Mol Sci 2023; 24:ijms24076602. [PMID: 37047574 PMCID: PMC10095287 DOI: 10.3390/ijms24076602] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/05/2023] Open
Abstract
Mild traumatic brain injury (mTBI) accounts for approximately 80% of all TBI cases and is a growing source of morbidity and mortality worldwide. To improve the management of children and adults with mTBI, a series of candidate biomarkers have been investigated in recent years. In this context, the measurement of blood biomarkers in the acute phase after a traumatic event helps reduce unnecessary CT scans and hospitalizations. In athletes, improved management of sports-related concussions is also sought to ensure athletes’ safety. S100B protein has emerged as the most widely studied and used biomarker for clinical decision making in patients with mTBI. In addition to its use as a diagnostic biomarker, S100B plays an active role in the molecular pathogenic processes accompanying acute brain injury. This review describes S100B protein as a diagnostic tool as well as a potential therapeutic target in patients with mTBI.
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Affiliation(s)
- Charlotte Oris
- Biochemistry and Molecular Genetic Department, University Hospital, F-63000 Clermont-Ferrand, France
- Faculty of Medicine of Clermont-Ferrand, Université Clermont Auvergne, CNRS, Inserm, GReD, F-63000 Clermont-Ferrand, France
| | - Samy Kahouadji
- Biochemistry and Molecular Genetic Department, University Hospital, F-63000 Clermont-Ferrand, France
- Faculty of Medicine of Clermont-Ferrand, Université Clermont Auvergne, CNRS, Inserm, GReD, F-63000 Clermont-Ferrand, France
| | - Julie Durif
- Biochemistry and Molecular Genetic Department, University Hospital, F-63000 Clermont-Ferrand, France
| | - Damien Bouvier
- Biochemistry and Molecular Genetic Department, University Hospital, F-63000 Clermont-Ferrand, France
- Faculty of Medicine of Clermont-Ferrand, Université Clermont Auvergne, CNRS, Inserm, GReD, F-63000 Clermont-Ferrand, France
| | - Vincent Sapin
- Biochemistry and Molecular Genetic Department, University Hospital, F-63000 Clermont-Ferrand, France
- Faculty of Medicine of Clermont-Ferrand, Université Clermont Auvergne, CNRS, Inserm, GReD, F-63000 Clermont-Ferrand, France
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16
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Kelmendi FM, Morina AA, Mekaj AY, Dragusha S, Ahmeti F, Alimehmeti R, Morina Q, Berisha M, Krasniqi B, Kerolli B. Ability of S100B to predict post-concussion syndrome in paediatric patients who present to the emergency department with mild traumatic brain injury. Br J Neurosurg 2023; 37:53-58. [PMID: 33565911 DOI: 10.1080/02688697.2021.1878487] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Among children who sustain mild traumatic brain injury (mTBI), 10-30% develop a cluster of cognitive, physical, and emotional symptoms commonly referred to as post-concussion syndrome (PCS). Symptoms typically resolve within 7-10 days, but a minority of patients report symptoms that persist for months or even years. The aim of our study was to identify a neurobiochemical marker after mTBI that can predict the presence of post-concussion syndrome three months after head injury in paediatric patients. MATERIALS AND METHODS Children between 7 and 16 years of age who had head trauma and no other complaints were included. Three months after the initial visit, participants or parents/guardians were interviewed in person about the children's PCS symptoms using the Rivermead Post-Concussion Symptoms Questionnaire (RPQ). RESULTS The mean value of S100B protein in serum in 38 patients without signs of PCS was 0.266 μg L-1, with a 95% confidence interval (CI) of 0.221 - 0.310 μg L-1. Among the 22 patients with signs of PCS, the mean value of S100B protein in serum was 0.845 μg L-1, with a 95% CI of 0.745-0.945 μg L-1. Patients with signs of PCS had higher S100B protein levels than those without signs of PCS (p < 0.0001). CONCLUSIONS Our prospective study showed that S100B protein is a useful neurobiomarker for detecting paediatric patients at risk for post-concussion syndrome. We found that the biomarker S100B correlated with the severity of traumatic brain injury (number of lesions on CT) and the presence of post-concussion syndrome.
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Affiliation(s)
- Fatos M Kelmendi
- Clinic of Neurosurgery, University Clinical Center of Kosovo, Prishtina, Kosovo
| | - Arsim A Morina
- Clinic of Neurosurgery, University Clinical Center of Kosovo, Prishtina, Kosovo
| | - Agon Y Mekaj
- Clinic of Neurosurgery, Faculty of Medicine, University of Prishtina, Prishtina, Kosovo
| | - Shefki Dragusha
- Clinic of Neurosurgery, University Clinical Center of Kosovo, Prishtina, Kosovo
| | - Feti Ahmeti
- Clinic of Neurosurgery, University Clinical Center of Kosovo, Prishtina, Kosovo
| | - Ridvan Alimehmeti
- Service of Neurosurgery, University Hospital Center"Mother Teresa", Tirana, Albania
| | - Qamile Morina
- Clinic of Anaesthesiology, University Clinical Center of Kosovo, Prishtina, Kosovo
| | - Murat Berisha
- Clinic of Paediatric Surgery, University Clinical Center of Kosovo, Prishtina, Kosovo
| | - Blerim Krasniqi
- College of Medical Science ''REZONANCA'' Gllokute Shelgjet" Veternik", Prishtina, Kosovo
| | - Berat Kerolli
- Clinic of Neurosurgery, University Clinical Center of Kosovo, Prishtina, Kosovo
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17
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H Hopman J, A L Santing J, A Foks K, J Verheul R, M van der Linden C, L van den Brand C, Jellema K. Biomarker S100B in plasma a screening tool for mild traumatic brain injury in an emergency department. Brain Inj 2023; 37:47-53. [PMID: 36397287 DOI: 10.1080/02699052.2022.2145360] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION A computerized tomography (CT) scan is an effective test for detecting traumatic intracranial findings after mild traumatic brain injury (mTBI). However, a head CT is costly, and can only be performed in a hospital. OBJECTIVE To determine if the addition of plasma S100B to clinical guidelines could lead to a more selective scanning strategy without compromising safety. METHODS We conducted a single center prospective cohort study at the emergency department. Patients (≥16 years) who received head CT and had a blood draw were included. The primary outcome was the accuracy of plasma S100B to predict the presence of any traumatic intracranial lesion on head CT. RESULTS We included 495 patients, out of the 74 patients who had traumatic intracranial lesions, 5 patients had a plasma S100B level below the cutoff value of 0.105 ug/L. For the detection of traumatic intracranial injury, S100B had a sensitivity of 0.932 , a specificity of 0.157, a negative predictive value of 0.930, and a positive predictive value of 0.163. CONCLUSIONS Among patients undergoing guideline-based CT scan for mTBI, the use of S100B, would results in a further decrease (14.8%) of CT scans but at a cost of missed injury, without clinical consequence, on CT.
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Affiliation(s)
- Joëlla H Hopman
- Department of Emergency Medicine, Haaglanden Medical Center, The Hague, The Netherlands
| | | | - Kelly A Foks
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Rolf J Verheul
- Department of Clinical Chemistry and Laboratory Medicine, Haaglanden Medical Center, The Hague
| | | | | | - Korné Jellema
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
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18
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Esser T, Gruber C, Bürkner A, Buchmann N, Minzlaff P, Prodinger PM. [Traumatic brain injuries in winter sports : An overview based on the winter sports skiing, snowboarding and ice hockey]. ORTHOPADIE (HEIDELBERG, GERMANY) 2022; 51:920-928. [PMID: 36227361 DOI: 10.1007/s00132-022-04318-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
In winter sports, skiers, snowboarders and ice hockey players have the highest risk of traumatic brain injuries (TBI). In skiing/snowboarding severe TBIs are of concern; in ice hockey, repetitive minor TBIs are frequent. The main causes of TBI in recreational skiing are collisions with trees; in professionals falls due to technical or tactical mistakes are the main causes. In ice hockey 10-15% of all injuries are due to a sports-related concussion (SRC), mostly caused by player-opponent contact. The pathomechanism in TBI is a combination of rotational and linear acceleration during head impact, which causes a diffuse axonal injury. Long-term complications such as neurodegenerative diseases and functional deficits are of relevance. Prevention by wearing helmets is effective, but less effective in TBI/SRC than in focal injuries.
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Affiliation(s)
- T Esser
- Abteilung für Unfallchirurgie und Orthopädie, Krankenhaus Agatharied, Norbert Kerkel Platz, 83734, Hausham, Deutschland
| | - C Gruber
- Abteilung für Unfallchirurgie und Orthopädie, Krankenhaus Agatharied, Norbert Kerkel Platz, 83734, Hausham, Deutschland
| | - A Bürkner
- Abteilung für Unfallchirurgie und Orthopädie, Krankenhaus Agatharied, Norbert Kerkel Platz, 83734, Hausham, Deutschland
| | - N Buchmann
- Abteilung für Unfallchirurgie und Orthopädie, Krankenhaus Agatharied, Norbert Kerkel Platz, 83734, Hausham, Deutschland
| | - P Minzlaff
- Abteilung für Unfallchirurgie und Orthopädie, Krankenhaus Agatharied, Norbert Kerkel Platz, 83734, Hausham, Deutschland
| | - P M Prodinger
- Abteilung für Unfallchirurgie und Orthopädie, Krankenhaus Agatharied, Norbert Kerkel Platz, 83734, Hausham, Deutschland.
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Steinmüller JB, Lynnerup NM, Steinmetz J, Riis JJ, Doering P. Implementation of the S100 Calcium-Binding Protein B Biomarker in a Clinical Setting: A Retrospective Study of Benefits, Safety, and Effectiveness. Neurotrauma Rep 2022; 3:447-455. [PMID: 36337079 PMCID: PMC9622208 DOI: 10.1089/neur.2021.0078] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Recent years have seen the emergence of the S100 calcium-binding protein B (S100B) biomarker used in the initial management of minor traumatic brain injury (TBI) patients. S100B has been found to reduce cerebral computed tomography (CT-C) scans and was recently implemented in the Scandinavian Neurotrauma Committee (SNC) guidelines. In a clinical setup, we retrospectively investigated the use of the S100B biomarker in relation to the SNC guidelines in the respective year before and after implementation. Accordingly, minor TBI patients with the International Classification of Diseases, Tenth Revision diagnostic code of S06.0 commotio cerebri were included in 2018 (n = 786) and 2019 (n = 709) for comparison of emergency department time (EDT) and CT-Cs. In 2019, we included all patients with an S100B sample (n = 547; 348/199 male:female; median age, 52 years). We found an S100B sensitivity of 92% and negative predictive value (NPV) of 99% (cutoff, 0.10 μg/L) regardless of SNC guideline compliance. With strict SNC guideline management, sensitivity and NPV increased to 100%, even at a 0.20-μg/L cutoff that increased the specificity from 49% to 76%. After S100B implementation, we found the median EDT to significantly increase from 196 min (interquartile range [IQR] = 127–289) in 2018 to 216 min (IQR = 134.0–309.5) in 2019 (p = 0.0148), which may have resulted from poor guideline compliance (53.9%). Contrarily, the proportion of CT-C scanned patients decreased from 70% to 56.3% equal to a relative 27.5% decrease of scanned patients (p < 0.0001). Conclusively, our study supported the safe and efficient clinical use of the S100B biomarker, albeit with a minor EDT increase. S100B combination with the SNC guidelines improved clinical potential.
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Affiliation(s)
| | | | - Jacob Steinmetz
- Department of Anesthesia and Trauma Centre, Centre of Head and Orthopedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,The Danish Air Ambulance, Aarhus, Denmark
| | - Jens Jakob Riis
- Department of Neurosurgery, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Doering
- Department of Orthopedic Surgery, Aalborg University Hospital, Aalborg, Denmark.,Address correspondence to: Peter Doering, MD, PhD, Aleris Denmark, Spine Unit, Aleris, Denmark.
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20
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Siahaan AMP, Fernando ET. The Potential of S100 Calcium-Binding Protein B and Glial Fibrillary Acid Protein in Predicting the Intracranial Lesions in Mild Traumatic Brain Injury: A Systematic Review of Literature. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
ABSTRACT
AIM: To summarize the current evidence of S100B and GFAP in predicting intracranial lesions after mTBI.
MATERIAL AND METHODS: We searched publications on biomarkers in mTBI from Web of Science, PubMed, and Scopus between January 1990 and July 2021. We included RCTs, cohort, case control, and cross-sectional studies that involved patients with acute closed mTBI in all age group in which head CT scan and blood-based biomarkers (GFAP and S100B) examination were conducted under 24 hours. This study was registered in Open Science Framework.
RESULTS: The initial search identified 4.937 article, in which 127 were included for full-text assessment. A total of 16 articles were finally included. No RCT was found in literature searching. Thirteen studies were studying S100B and three studies were studying GFAP. Nine out of 13 S100B studies shows a promising result with ≥ 95% sensitivity for detecting intracranial lesions. Majorities (11 /13) studies of S100B confirmed that S100B reduced the unnecessary usage of CT scan. GFAP concentration significantly increased in CT+ patient than CT- patient. No specific GFAP cut off value between the studies was found.
CONCLUSION: The result showed that S100B and GFAP had potential to predict the occurrence of intracranial lesions. Variance between methodologies and cut off value hindered the quality of evidence, especially in GFAP.
KEYWORDS: mild traumatic brain injury, S100B, GFAP.
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21
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Kahouadji S, Bouillon-Minois JB, Oris C, Durif J, Pereira B, Pinguet J, Rozand A, Schmidt J, Sapin V, Bouvier D. Evaluation of serum neurofilament light in the early management of mTBI patients. Clin Chem Lab Med 2022; 60:1234-1241. [PMID: 35511901 DOI: 10.1515/cclm-2022-0173] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/20/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Serum S100B allows a one-third reduction of computed tomography (CT) scans performed for mild traumatic brain injury (mTBI) patients. In this study, we evaluated the diagnostic performance of serum NF-L in the detection of intracranial lesions induced by mTBI. METHODS One hundred seventy-nine adult mTBI patients presenting to the emergency department of Clermont-Ferrand University Hospital with a Glasgow Coma Scale (GCS) score of 14-15 were included. S100B assays were performed for clinical routine while NF-L samples were stored at -80 °C until analysis. CT scans were performed for patients with S100B levels above the decision threshold of 0.10 μg/L. Later, NF-L and S100B levels were compared to CT scan findings to evaluate the biomarkers' performances. RESULTS The area under the ROC curve (AUC) evaluating the diagnostic ability in the prediction of intracranial lesions was 0.72 (95% CI; 0.58-0.87) for S100B and 0.58 (95% CI; 0.45-0.71) for NF-L, the specificities (at a threshold allowing a 100% sensitivity) were 35.7% for S100B, and 28% for NF-L (p=0.096). AUCs of NF-L and S100B for the identification of patients with neurological disorders were statistically different (p<0.001). The AUCs were 0.87 (95% CI; 0.82-0.93) for NF-L and 0.57 (95% CI; 0.48-0.66) for S100B. There was a poor correlation between NF-L and S100B, and NF-L levels were correlated to patients' age (Spearman coefficient of 0.79). CONCLUSIONS NF-L showed poor performances in the early management of mTBI patients. NF-L levels are strongly correlated to neurodegeneration, whether physiological, age-related, or pathological.
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Affiliation(s)
- Samy Kahouadji
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Charlotte Oris
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Clermont-Ferrand, France.,Université Clermont Auvergne, CNRS, INSERM, GReD, Clermont-Ferrand, France
| | - Julie Durif
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics Unit (DRCI), CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Jérémy Pinguet
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Agathe Rozand
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Jeannot Schmidt
- Adult Emergency Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Vincent Sapin
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Clermont-Ferrand, France.,Université Clermont Auvergne, CNRS, INSERM, GReD, Clermont-Ferrand, France
| | - Damien Bouvier
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Clermont-Ferrand, France.,Université Clermont Auvergne, CNRS, INSERM, GReD, Clermont-Ferrand, France
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22
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S100ß protein for non-traumatic subarachnoid hemorrhage diagnosis. Am J Emerg Med 2022; 57:39-41. [DOI: 10.1016/j.ajem.2022.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 04/09/2022] [Indexed: 11/22/2022] Open
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23
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Rogan A, O'Sullivan MB, Holley A, McQuade D, Larsen P. Can serum biomarkers be used to rule out significant intracranial pathology in emergency department patients with mild traumatic brain injury? A Systemic Review & Meta-Analysis. Injury 2022; 53:259-271. [PMID: 34763896 DOI: 10.1016/j.injury.2021.10.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/14/2021] [Accepted: 10/16/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Interest has mounted into the use of objective clinical biomarkers for traumatic brain injury (TBI). This systematic review and meta-analysis aimed to synthesise the existing evidence investigating the use of serum & plasma biomarkers to exclude significant intracranial injuries seen on CT head scans in patients that present to ED with TBI. METHODS The primary outcome was to review the diagnostic accuracy (sensitivity & specificity) of S100B, GFAP and UCH-L1 to exclude significant intracranial pathology on CT head scan in adults presenting with TBI. Secondary outcomes investigated biomarker performance at different time points, in isolated TBI and multi-trauma and with pre-specified cut offs. Systematic searches were conducted on MEDLINE ® (via PubMed), Cochrane electronic databases and EMBASE from 1st January 2000 until June 2020. Bias was assessed using QUADAS 2 tool. A narrative synthesis and meta-analysis were performed. PROSPERO registration number CRD42020212206. RESULTS After screening, 22 papers were included. The total number of patients with TBI was 9,416. There was significant variation regarding study design, population selection and the clinical threshold/decision rule for CT head request. The diagnostic accuracy of S100B as measured by the range of individual sensitivities and specificities were 63-100% and 5-58%, respectively. Individual sensitivities and specificities for GFAP were 67-100% and 0-89% and for UCH-L1 were 61-100% and 21-63.7% respectively. When measured within 3 hours individual sensitivities & specificities for S100B were 98-100% & 20-58% respectively. The quality of evidence for the primary outcome overall was low. The quality of evidence was low for all secondary outcomes apart from studies that used a pre-specified cut off for S100B which had a moderate strength of evidence. CONCLUSION The overall quality of evidence regarding the diagnostic accuracy of single biomarkers as a rule out for significant intracranial injury seen on CT head scans in ED patients with TBI is low. Based on current evidence, S100B is the only single biomarker with a validated clinical platform, pre-determined cut off threshold and moderate quality evidence; at this stage making it the biomarker of choice. More robust clinical outcome and economic impact data is required to support its incorporation into clinical decision tools.
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Affiliation(s)
- Alice Rogan
- Emergency Medicine Research Fellow, Department of Surgery and Anaesthesia, School of Medicine and Health Sciences, University of Otago, Wellington, PO Box 7343, Wellington South 6242, New Zealand.
| | | | - Ana Holley
- Lecturer, Department of Surgery and Anaesthesia, University of Otago (Wellington).
| | - David McQuade
- Emergency Medicine Specialist (FACEM), Wellington Regional Hospital Emergency Department.
| | - Peter Larsen
- Associate Professor, Department of Surgery and Anaesthesia, University of Otago (Wellington).
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24
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Biberthaler P, Musaelyan K, Krieg S, Meyer B, Stimmer H, Zapf J, von Matthey F, Chandran R, Marino JA, Beligere G, Hoffmann M, Zhang H, Datwyler SA, McQuiston B. Evaluation of Acute Glial Fibrillary Acidic Protein and Ubiquitin C-Terminal Hydrolase-L1 Plasma Levels in Traumatic Brain Injury Patients with and without Intracranial Lesions. Neurotrauma Rep 2022; 2:617-625. [PMID: 35018363 PMCID: PMC8742277 DOI: 10.1089/neur.2021.0048] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This pilot study aimed to evaluate the association of plasma ubiquitin C-terminal hydrolase-L1 (UCH-L1), glial fibrillary acidic protein (GFAP), and S100 calcium-binding protein B (S100B) with intracranial abnormalities visible on a computed tomography (CT) scan (CT positive) and injury severity in acute traumatic brain injury (TBI). For these purposes, a cohort of 109 adult TBI patients was recruited within 6 h from the injury event. A hyperacute subcohort of 20 patients who had their blood collected within 2 h from injury was analyzed separately for early acute biomarker levels. Levels of GFAP and UCH-L1 were analyzed using the prototype Abbott i-STAT™ TBI Plasma Test (Abbott Laboratories, Abbot Park, IL), alongside S100B measurement (Elecsys; Roche Diagnostics, Penzberg, Germany). In the hyperacute subcohort, GFAP and UCH-L1, but not S100B, levels were significantly higher in the CT-positive group compared to CT-negative patients. AUC values for differentiation between CT-positive and CT-negative patients were 0.97 for GFAP, 0.87 for UCH-L1, and 0.60 for S100B. Severity discrimination, defined by Glasgow Coma Scale (GCS) score, was then analyzed in the total patient cohort. Levels of all three biomarkers were significantly different between mild (GCS, 13-15) and moderate/severe (GCS, 3-12) injury groups. UCH-L1 showed the highest area under the curve value for severity discrimination (0.94), followed by GFAP (0.91) and S100B (0.83). These results support the clinical utility of GFAP and UCH-L1 as TBI biomarkers able to rule out CT-positive injury in acute TBI. Moreover, excellent differentiation of GFAP and UCH-L1 between mild and moderate/severe TBI groups affirms their close association with the underlying pathology.
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Affiliation(s)
- Peter Biberthaler
- Department of Trauma Surgery, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Ksenia Musaelyan
- Core Diagnostics, Abbott Laboratories, Abbott Park, Illinois, USA
| | - Sandro Krieg
- Department of Neurosurgery, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Herbert Stimmer
- Department of Radiology, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Julian Zapf
- Department of Trauma Surgery, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Francesca von Matthey
- Department of Trauma Surgery, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Raj Chandran
- Core Diagnostics, Abbott Laboratories, Abbott Park, Illinois, USA
| | - Jaime A Marino
- Core Diagnostics, Abbott Laboratories, Abbott Park, Illinois, USA
| | | | - Markus Hoffmann
- Core Diagnostics, Abbott Laboratories, Abbott Park, Illinois, USA
| | - Hongwei Zhang
- Point of Care Division, Abbott Laboratories, Abbott Park, Illinois, USA
| | - Saul A Datwyler
- Core Diagnostics, Abbott Laboratories, Abbott Park, Illinois, USA
| | - Beth McQuiston
- Core Diagnostics, Abbott Laboratories, Abbott Park, Illinois, USA
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25
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Dennis EL, Baron D, Bartnik‐Olson B, Caeyenberghs K, Esopenko C, Hillary FG, Kenney K, Koerte IK, Lin AP, Mayer AR, Mondello S, Olsen A, Thompson PM, Tate DF, Wilde EA. ENIGMA brain injury: Framework, challenges, and opportunities. Hum Brain Mapp 2022; 43:149-166. [PMID: 32476212 PMCID: PMC8675432 DOI: 10.1002/hbm.25046] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/23/2020] [Accepted: 05/03/2020] [Indexed: 12/19/2022] Open
Abstract
Traumatic brain injury (TBI) is a major cause of disability worldwide, but the heterogeneous nature of TBI with respect to injury severity and health comorbidities make patient outcome difficult to predict. Injury severity accounts for only some of this variance, and a wide range of preinjury, injury-related, and postinjury factors may influence outcome, such as sex, socioeconomic status, injury mechanism, and social support. Neuroimaging research in this area has generally been limited by insufficient sample sizes. Additionally, development of reliable biomarkers of mild TBI or repeated subconcussive impacts has been slow, likely due, in part, to subtle effects of injury and the aforementioned variability. The ENIGMA Consortium has established a framework for global collaboration that has resulted in the largest-ever neuroimaging studies of multiple psychiatric and neurological disorders. Here we describe the organization, recent progress, and future goals of the Brain Injury working group.
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Affiliation(s)
- Emily L. Dennis
- Department of NeurologyUniversity of Utah School of MedicineSalt Lake CityUtahUSA
- George E. Wahlen Veterans Affairs Medical CenterSalt Lake CityUtahUSA
- Imaging Genetics CenterStevens Neuroimaging & Informatics Institute, Keck School of Medicine of USCMarina del ReyCaliforniaUSA
| | - David Baron
- Western University of Health SciencesPomonaCaliforniaUSA
| | - Brenda Bartnik‐Olson
- Department of RadiologyLoma Linda University Medical CenterLoma LindaCaliforniaUSA
| | - Karen Caeyenberghs
- Cognitive Neuroscience Unit, School of PsychologyDeakin UniversityBurwoodVictoriaAustralia
| | - Carrie Esopenko
- Department of Rehabilitation and Movement SciencesRutgers Biomedical Health SciencesNewarkNew JerseyUSA
| | - Frank G. Hillary
- Department of PsychologyPennsylvania State UniversityUniversity ParkPennsylvaniaUSA
- Social Life and Engineering Sciences Imaging CenterUniversity ParkPennsylvaniaUSA
| | - Kimbra Kenney
- Department of NeurologyUniformed Services University of the Health SciencesBethesdaMarylandUSA
- National Intrepid Center of ExcellenceWalter Reed National Military Medical CenterBethesdaMarylandUSA
| | - Inga K. Koerte
- Psychiatry Neuroimaging LaboratoryBrigham and Women's HospitalBostonMassachusettsUSA
- Department of Child and Adolescent Psychiatry, Psychosomatics and PsychotherapyLudwig‐Maximilians‐UniversitätMunichGermany
| | - Alexander P. Lin
- Center for Clinical SpectroscopyBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Andrew R. Mayer
- Mind Research NetworkAlbuquerqueNew MexicoUSA
- Department of Neurology and PsychiatryUniversity of New Mexico School of MedicineAlbuquerqueNew MexicoUSA
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional ImagingUniversity of MessinaMessinaItaly
| | - Alexander Olsen
- Department of PsychologyNorwegian University of Science and TechnologyTrondheimNorway
- Department of Physical Medicine and RehabilitationSt. Olavs Hospital, Trondheim University HospitalTrondheimNorway
| | - Paul M. Thompson
- Imaging Genetics CenterStevens Neuroimaging & Informatics Institute, Keck School of Medicine of USCMarina del ReyCaliforniaUSA
- Department of Neurology, Pediatrics, Psychiatry, Radiology, Engineering, and OphthalmologyUniversity of Southern California (USC)Los AngelesCaliforniaUSA
| | - David F. Tate
- Department of NeurologyUniversity of Utah School of MedicineSalt Lake CityUtahUSA
- George E. Wahlen Veterans Affairs Medical CenterSalt Lake CityUtahUSA
| | - Elisabeth A. Wilde
- Department of NeurologyUniversity of Utah School of MedicineSalt Lake CityUtahUSA
- George E. Wahlen Veterans Affairs Medical CenterSalt Lake CityUtahUSA
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26
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Amoo M, Henry J, O'Halloran PJ, Brennan P, Husien MB, Campbell M, Caird J, Javadpour M, Curley GF. S100B, GFAP, UCH-L1 and NSE as predictors of abnormalities on CT imaging following mild traumatic brain injury: a systematic review and meta-analysis of diagnostic test accuracy. Neurosurg Rev 2021; 45:1171-1193. [PMID: 34709508 DOI: 10.1007/s10143-021-01678-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 09/03/2021] [Accepted: 10/20/2021] [Indexed: 12/25/2022]
Abstract
Biomarkers such as calcium channel binding protein S100 subunit beta (S100B), glial fibrillary acidic protein (GFAP), ubiquitin c-terminal hydrolase L1 (UCH-L1) and neuron-specific enolase (NSE) have been proposed to aid in screening patients presenting with mild traumatic brain injury (mTBI). As such, we aimed to characterise their accuracy at various thresholds. MEDLINE, SCOPUS and EMBASE were searched, and articles reporting the diagnostic performance of included biomarkers were eligible for inclusion. Risk of bias was assessed using the QUADAS-II criteria. A meta-analysis was performed to assess the predictive value of biomarkers for imaging abnormalities on CT. A total of 2939 citations were identified, and 38 studies were included. Thirty-two studies reported data for S100B. At its conventional threshold of 0.1 μg/L, S100B had a pooled sensitivity of 91% (95%CI 87-94) and a specificity of 30% (95%CI 26-34). The optimal threshold for S100B was 0.72 μg/L, with a sensitivity of 61% (95% CI 50-72) and a specificity of 69% (95% CI 64-74). Nine studies reported data for GFAP. The optimal threshold for GFAP was 626 pg/mL, at which the sensitivity was 71% (95%CI 41-91) and specificity was 71% (95%CI 43-90). Sensitivity of GFAP was maximised at a threshold of 22 pg/mL, which had a sensitivity of 93% (95%CI 73-99) and a specificity of 36% (95%CI 12-68%). Three studies reported data for NSE and two studies for UCH-L1, which precluded meta-analysis. There is evidence to support the use of S100B as a screening tool in mild TBI, and potential advantages to the use of GFAP, which requires further investigation.
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Affiliation(s)
- Michael Amoo
- Department of Neurosurgery, Royal College of Surgeons in Ireland, Dublin, Ireland. .,National Neurosurgical Centre, Beaumont Hospital, Dublin 9, Ireland. .,Beacon Academy, Beacon Hospital, Sandyford, Dublin 18, Ireland.
| | - Jack Henry
- National Neurosurgical Centre, Beaumont Hospital, Dublin 9, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Philip J O'Halloran
- Department of Neurosurgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Paul Brennan
- Department of Neurosurgery, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Radiology, Beaumont Hospital, Dublin 9, Ireland
| | - Mohammed Ben Husien
- Department of Neurosurgery, Royal College of Surgeons in Ireland, Dublin, Ireland.,National Neurosurgical Centre, Beaumont Hospital, Dublin 9, Ireland
| | - Matthew Campbell
- Department of Genetics, Trinity College Dublin, Dublin 2, Ireland
| | - John Caird
- Department of Neurosurgery, Royal College of Surgeons in Ireland, Dublin, Ireland.,National Neurosurgical Centre, Beaumont Hospital, Dublin 9, Ireland
| | - Mohsen Javadpour
- Department of Neurosurgery, Royal College of Surgeons in Ireland, Dublin, Ireland.,National Neurosurgical Centre, Beaumont Hospital, Dublin 9, Ireland.,Department of Academic Neurology, Trinity College Dublin, Dublin 2, Ireland
| | - Gerard F Curley
- Department of Neurosurgery, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Anaesthesia and Critical Care, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
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27
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Oris C, Bouillon-Minois JB, Pinguet J, Kahouadji S, Durif J, Meslé V, Pereira B, Schmidt J, Sapin V, Bouvier D. Predictive Performance of Blood S100B in the Management of Patients Over 65 Years Old With Mild Traumatic Brain Injury. J Gerontol A Biol Sci Med Sci 2021; 76:1471-1479. [PMID: 33647933 DOI: 10.1093/gerona/glab055] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We previously assessed the inclusion of S100B blood determination into clinical decision rules for mild traumatic brain injury (mTBI) management in the Emergency Department (ED) of Clermont-Ferrand Hospital. At the 0.10 µg/L threshold, S100B reduced the use of cranial computed tomography (CCT) scan in adults by at least 30% with a ~100% sensitivity. Older patients had higher serum S100B values, resulting in lower specificity (18.7%) and decreased CCT reduction. We conducted this study to confirm the age effect on S100B concentrations, and to propose new decisional thresholds for older patients. METHODS A total of 1172 mTBI patients aged 65 and over were included. They were divided into 3 age groups: 65-79, 80-89, and ≥ 90 years old. S100B's performance to identify intracranial lesions (sensitivity [SE] and specificity [SP]) was assessed using the routine 0.10 µg/L threshold and also other more efficient thresholds established for each age group. RESULTS S100B concentration medians were 0.18, 0.26, and 0.32 µg/L for the 65-79, 80-89, and ≥ 90 years old age groups, respectively (p < .001). The most efficient thresholds were 0.11 µg/L for the 65-79 age group and 0.15 µg/L for the other groups. At these new thresholds, SP was respectively 28.4%, 34.3%, and 20.5% for each age group versus 24.9%, 18.2%, and 10.5% at the 0.10 µg/L threshold. CONCLUSIONS Adjustment of the S100B threshold is necessary in older patients' management. An increased threshold of 0.15 µg/L is particularly interesting for patients ≥ 80 years old, allowing a significant increase of CCT scan reduction (29.3%).
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Affiliation(s)
- Charlotte Oris
- University Hospital, Biochemistry and Molecular Genetic Department, Clermont-Ferrand, France.,Clermont Auvergne University, CNRS 6293, INSERM 1103, GReD, Clermont-Ferrand, France
| | | | - Jérémy Pinguet
- University Hospital, Biochemistry and Molecular Genetic Department, Clermont-Ferrand, France
| | - Samy Kahouadji
- University Hospital, Biochemistry and Molecular Genetic Department, Clermont-Ferrand, France
| | - Julie Durif
- University Hospital, Biochemistry and Molecular Genetic Department, Clermont-Ferrand, France
| | - Vallauris Meslé
- Clermont Auvergne University, CNRS 6293, INSERM 1103, GReD, Clermont-Ferrand, France
| | - Bruno Pereira
- University Hospital, Biostatistics unit (DRCI) Department, Clermont-Ferrand, France
| | - Jeannot Schmidt
- University Hospital, Adult Emergency Department, Clermont-Ferrand, France
| | - Vincent Sapin
- University Hospital, Biochemistry and Molecular Genetic Department, Clermont-Ferrand, France.,Clermont Auvergne University, CNRS 6293, INSERM 1103, GReD, Clermont-Ferrand, France
| | - Damien Bouvier
- University Hospital, Biochemistry and Molecular Genetic Department, Clermont-Ferrand, France.,Clermont Auvergne University, CNRS 6293, INSERM 1103, GReD, Clermont-Ferrand, France
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28
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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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Diagnostic accuracy of prehospital serum S100B and GFAP in patients with mild traumatic brain injury: a prospective observational multicenter cohort study - "the PreTBI I study". Scand J Trauma Resusc Emerg Med 2021; 29:75. [PMID: 34078435 PMCID: PMC8173808 DOI: 10.1186/s13049-021-00891-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/18/2021] [Indexed: 12/02/2022] Open
Abstract
Background The biomarker serum S100 calcium-binding protein B (S100B) is used in in-hospital triage of adults with mild traumatic brain injury to rule out intracranial lesions. The biomarker glial fibrillary acidic protein (GFAP) is suggested as a potential diagnostic biomarker for traumatic brain injury. The aim of this study was to investigate the diagnostic accuracy of early prehospital S100B and GFAP measurements to rule out intracranial lesions in adult patients with mild traumatic brain injury. Methods Prehospital and in-hospital blood samples were drawn from 566 adult patients with mild traumatic brain injury (Glasgow Coma Scale Score 14–15). The index test was S100B and GFAP concentrations. The reference standard was endpoint adjudication of the traumatic intracranial lesion based on medical records. The primary outcome was prehospital sensitivity of S100B in relation to the traumatic intracranial lesion. Results Traumatic intracranial lesions were found in 32/566 (5.6%) patients. The sensitivity of S100B > 0.10 μg/L was 100% (95%CI: 89.1;100.0) in prehospital samples and 100% (95% CI 89.1;100.0) in in-hospital samples. The specificity was 15.4% (95%CI: 12.4;18.7) in prehospital samples and 31.5% (27.5;35.6) in in-hospital samples. GFAP was only detected in less than 2% of cases with the assay used. Conclusion Early prehospital and in-hospital S100B levels < 0.10 μg/L safely rules out traumatic intracranial lesions in adult patients with mild traumatic brain injury, but specificity is lower with early prehospital sampling than with in-hospital sampling. The very limited cases with values detectable with our assay do not allow conclusions to be draw regarding the diagnostic accuracy of GFAP. Trial registration ClinicalTrials.gov identifier: NCT02867137. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00891-5.
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Turner S, Lazarus R, Marion D, Main KL. Molecular and Diffusion Tensor Imaging Biomarkers of Traumatic Brain Injury: Principles for Investigation and Integration. J Neurotrauma 2021; 38:1762-1782. [PMID: 33446015 DOI: 10.1089/neu.2020.7259] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The last 20 years have seen the advent of new technologies that enhance the diagnosis and prognosis of traumatic brain injury (TBI). There is recognition that TBI affects the brain beyond initial injury, in some cases inciting a progressive neuropathology that leads to chronic impairments. Medical researchers are now searching for biomarkers to detect and monitor this condition. Perhaps the most promising developments are in the biomolecular and neuroimaging domains. Molecular assays can identify proteins indicative of neuronal injury and/or degeneration. Diffusion imaging now allows sensitive evaluations of the brain's cellular microstructure. As the pace of discovery accelerates, it is important to survey the research landscape and identify promising avenues of investigation. In this review, we discuss the potential of molecular and diffusion tensor imaging (DTI) biomarkers in TBI research. Integration of these technologies could advance models of disease prognosis, ultimately improving care. To date, however, few studies have explored relationships between molecular and DTI variables in patients with TBI. Here, we provide a short primer on each technology, review the latest research, and discuss how these biomarkers may be incorporated in future studies.
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Affiliation(s)
- Stephanie Turner
- Defense and Veterans Brain Injury Center, Silver Spring, Maryland, USA.,General Dynamics Information Technology, Falls Church, Virginia, USA
| | - Rachel Lazarus
- Defense and Veterans Brain Injury Center, Silver Spring, Maryland, USA.,General Dynamics Information Technology, Falls Church, Virginia, USA
| | - Donald Marion
- Defense and Veterans Brain Injury Center, Silver Spring, Maryland, USA.,General Dynamics Information Technology, Falls Church, Virginia, USA
| | - Keith L Main
- Defense and Veterans Brain Injury Center, Silver Spring, Maryland, USA.,General Dynamics Information Technology, Falls Church, Virginia, USA
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Sapin V, Gaulmin R, Aubin R, Walrand S, Coste A, Abbot M. Blood biomarkers of mild traumatic brain injury: State of art. Neurochirurgie 2021; 67:249-254. [PMID: 33482234 DOI: 10.1016/j.neuchi.2021.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 12/26/2020] [Accepted: 01/10/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Mild traumatic brain injury (mTBI) is one of the most common causes of emergency department visits around the world. Up to 90% of injuries are classified as mTBI. Cranial computed tomography (CCT) is a standard diagnosis tool to identify intracranial complications in adults with mTBI. Alternatively, children can be admitted for inpatient observation with CCT scans performed only on those with clinical deterioration. The use of blood biomarkers is a supplementary tool for identifying patients at risk of intracerebral lesions who may need imaging. METHOD We realised a bibliographic state of art providing a contemporary clinical and laboratory framework for blood biomarker testing in mTBI management. RESULTS The S100B protein is the only biomarker that can be used today in the clinical routine for management of mTBI with appropriate evidence-based medicine. Due to its excellent negative predictive value, S100B protein is an alternative choice to CCT scanning for mTBI management with considered, consensual and pragmatic use. In this state of art, we propose points to help clinicians and clinical pathologists use serum S100B protein in the clinical routine. A state of art on the different biomarkers (GFAP, UCH-L1, NF [H or L], tau, H-FABP, SNTF, NSE, miRNAs, MBP) is also conducted. Some of these other biomarkers, used alone (GFAP, UCH-L1) or in combination (GFAP+H-FABP±S100B±IL10) can improve the specificity of S100B. CONCLUSION Using a bibliographic state of art, we highlighted the added values of the blood biomarkers for the clinical management of mTBI.
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Affiliation(s)
- V Sapin
- Biochemistry and molecular biology department, CHU Gabriel-Montpied, Clermont-Ferrand, France.
| | - R Gaulmin
- ASM Clermont Auvergne, service médical, 63028 Clermont-Ferrand cedex 2, France
| | - R Aubin
- ASM Clermont Auvergne, service médical, 63028 Clermont-Ferrand cedex 2, France
| | - S Walrand
- Service de nutrition clinique, université Clermont Auvergne, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - A Coste
- Service de neurochirurgie, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - M Abbot
- ASM Clermont Auvergne, service médical, 63028 Clermont-Ferrand cedex 2, France; Service de médecine du sport, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
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32
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Gao X, Boryczka J, Zheng P, Kasani S, Yang F, Engler-Chiurazzi EB, Simpkins JW, Wigginton JG, Wu N. A "hot Spot"-Enhanced paper lateral flow assay for ultrasensitive detection of traumatic brain injury biomarker S-100β in blood plasma. Biosens Bioelectron 2021; 177:112967. [PMID: 33429202 DOI: 10.1016/j.bios.2021.112967] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/25/2020] [Accepted: 12/30/2020] [Indexed: 12/21/2022]
Abstract
Currently colorimetric paper lateral flow strips (PLFS) encounter two major limitations, that is, low sensitivity and severe interference from complex sample matrices such as blood. These shortcomings limit their application in detection of low-concentration analytes in complex samples. To solve these problems, a PLFS has been developed by utilizing surface-enhanced Raman scattering (SERS) for sensing signal transduction. In particular, a hierarchical three-dimensional nanostructure has been designed to create "hot spots", which can significantly amplify the SERS sensing signal, leading to high sensitivity. As a result, this PLFS has demonstrated a limit of detection (LOD) of 5.0 pg mL-1 toward detection of S-100β, a traumatic brain injury (TBI) protein biomarker in blood plasma. The PLFS has been successfully used for rapid measurement of S-100β in clinical TBI patient samples taken in the emergency department. Availability of PLFS for blood testing would shift the paradigm of TBI patient management and clinical outcome in emergency departments. It is expected that this type of PLFS can be adapted for rapid detection of various human diseases due to its capability of measuring a low level of protein blood biomarkers in complex human fluids.
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Affiliation(s)
- Xuefei Gao
- Department of Mechanical and Aerospace Engineering, West Virginia University, Morgantown, WV, 26506-6106, United States
| | - Jennifer Boryczka
- Department of Chemical Engineering, University of Massachusetts Amherst, Amherst, MA, 01003-9303, United States
| | - Peng Zheng
- Department of Mechanical and Aerospace Engineering, West Virginia University, Morgantown, WV, 26506-6106, United States
| | - Sujan Kasani
- Department of Mechanical and Aerospace Engineering, West Virginia University, Morgantown, WV, 26506-6106, United States
| | - Feng Yang
- Industrial and Management Systems Engineering Department, West Virginia University, Morgantown, WV, 26506, United States
| | - Elizabeth B Engler-Chiurazzi
- Department of Neuroscience, Center for Basic and Translational Stroke Research, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, 26505, United States
| | - James W Simpkins
- Department of Neuroscience, Center for Basic and Translational Stroke Research, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, 26505, United States
| | - Jane G Wigginton
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, 75390, United States
| | - Nianqiang Wu
- Department of Mechanical and Aerospace Engineering, West Virginia University, Morgantown, WV, 26506-6106, United States; Department of Chemical Engineering, University of Massachusetts Amherst, Amherst, MA, 01003-9303, United States.
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Blais Lécuyer J, Mercier É, Tardif PA, Archambault PM, Chauny JM, Berthelot S, Frenette J, Perry J, Stiell I, Émond M, Lee J, Lang E, McRae A, Boucher V, Le Sage N. S100B protein level for the detection of clinically significant intracranial haemorrhage in patients with mild traumatic brain injury: a subanalysis of a prospective cohort study. Emerg Med J 2020; 38:285-289. [PMID: 33355233 PMCID: PMC7982939 DOI: 10.1136/emermed-2020-209583] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 10/21/2020] [Accepted: 11/08/2020] [Indexed: 11/18/2022]
Abstract
Background Clinical assessment of patients with mild traumatic brain injury (mTBI) is challenging and overuse of head CT in the ED is a major problem. Several studies have attempted to reduce unnecessary head CTs following a mTBI by identifying new tools aiming to predict intracranial bleeding. Higher levels of S100B protein have been associated with intracranial haemorrhage following a mTBI in previous literature. The main objective of this study is to assess whether plasma S100B protein level is associated with clinically significant brain injury and could be used to reduce the number of head CT post-mTBI. Methods Study design: secondary analysis of a prospective multicentre cohort study conducted between 2013 and 2016 in five Canadian EDs. Inclusion criteria: non-hospitalised patients with mTBI with a GCS score of 13–15 in the ED and a blood sample drawn within 24 hours after the injury. Data collected: sociodemographic and clinical data were collected in the ED. S100B protein was analysed using ELISA. All CT scans were reviewed by a radiologist blinded to the biomarker results. Main outcome: the presence of clinically important brain injury. Results 476 patients were included. Mean age was 41±18 years old and 150 (31.5%) were women. Twenty-four (5.0%) patients had a clinically significant intracranial haemorrhage. Thirteen patients (2.7%) presented a non-clinically significant brain injury. A total of 37 (7.8%) brain injured patients were included in our study. S100B median value (Q1–Q3) was: 0.043 µg/L (0.008–0.080) for patients with clinically important brain injury versus 0.039 µg/L (0.023–0.059) for patients without clinically important brain injury. Sensitivity and specificity of the S100B protein level, if used alone to detect clinically important brain injury, were 16.7% (95% CI 4.7% to 37.4%) and 88.5% (95% CI 85.2% to 91.3%), respectively. Conclusion Plasma S100B protein level was not associated with clinically significant intracranial lesion in patients with mTBI.
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Affiliation(s)
- Julien Blais Lécuyer
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Quebec, Canada.,Axe de recherche en Santé des populations et pratiques optimales en santé, CHU de Quebec-Universite Laval Research Center, Quebec, Quebec, Canada
| | - Éric Mercier
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Quebec, Canada.,Axe de recherche en Santé des populations et pratiques optimales en santé, CHU de Quebec-Universite Laval Research Center, Quebec, Quebec, Canada
| | - Pier-Alexandre Tardif
- Axe de recherche en Santé des populations et pratiques optimales en santé, CHU de Quebec-Universite Laval Research Center, Quebec, Quebec, Canada
| | - Patrick M Archambault
- Department of Anesthesiology and Critical Care Medicine, Université Laval, Quebec, Quebec, Canada.,Chaudiere-Appalaches Integrated Health and Social Services Center, Lévis, Quebec, Canada
| | - Jean-Marc Chauny
- Department of family medicine and emergency medicine, University of Montreal, Montreal, Quebec, Canada
| | - Simon Berthelot
- Axe de recherche en Santé des populations et pratiques optimales en santé, CHU de Quebec-Universite Laval Research Center, Quebec, Quebec, Canada
| | - Jérôme Frenette
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Quebec, Canada
| | - Jeff Perry
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Quebec, Canada.,Department of emergency medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Ian Stiell
- Department of emergency medicine, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Marcel Émond
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Quebec, Canada.,Axe de recherche en Santé des populations et pratiques optimales en santé, CHU de Quebec-Universite Laval Research Center, Quebec, Quebec, Canada
| | - Jacques Lee
- Schwartz/Reisman Emergency Medicine Institute, Toronto, Ontario, Canada
| | - Eddy Lang
- Department of emergency medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrew McRae
- Department of emergency medicine, University of Calgary, Calgary, Alberta, Canada
| | - Valérie Boucher
- Axe de recherche en Santé des populations et pratiques optimales en santé, CHU de Quebec-Universite Laval Research Center, Quebec, Quebec, Canada
| | - Natalie Le Sage
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Quebec, Canada .,Axe de recherche en Santé des populations et pratiques optimales en santé, CHU de Quebec-Universite Laval Research Center, Quebec, Quebec, Canada
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Lorton F, Simon-Pimmel J, Masson D, Launay E, Gras-Le Guen C, Scherdel P. Impact of routine S100B protein assay on CT scan use in children with mild traumatic brain injury. Clin Chem Lab Med 2020; 59:875-882. [PMID: 33554555 DOI: 10.1515/cclm-2020-1293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/05/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To evaluate the impact of implementing a modified Pediatric Emergency Care Applied Research Network (PECARN) rule including the S100B protein assay for managing mild traumatic brain injury (mTBI) in children. METHODS A before-and-after study was conducted in a paediatric emergency department of a French University Hospital from 2013 to 2015. We retrospectively included all consecutive children aged 4 months to 15 years who presented mTBI and were at intermediate risk for clinically important traumatic brain injury (ciTBI). We compared the proportions of CT scans performed and of in-hospital observations before (2013-2014) and after (2014-2015) implementation of a modified PECARN rule including the S100B protein assay. RESULTS We included 1,062 children with mTBI (median age 4.5 years, sex ratio [F/M] 0.73) who were at intermediate risk for ciTBI: 494 (46.5%) during 2013-2014 and 568 (53.5%) during 2014-2015. During 2014-2015, S100B protein was measured in 451 (79.4%) children within 6 h after mTBI. The proportion of CT scans and in-hospital observations significantly decreased between the two periods, from 14.4 to 9.5% (p=0.02) and 73.9-40.5% (p<0.01), respectively. The number of CT scans performed to identify a single ciTBI was reduced by two-thirds, from 18 to 6 CT scans, between 2013-2014 and 2014-2015. All children with ciTBI were identified by the rules. CONCLUSIONS The implementation of a modified PECARN rule including the S100B protein assay significantly decreased the proportion of CT scans and in-hospital observations for children with mTBI who were at intermediate risk for ciTBI.
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Affiliation(s)
- Fleur Lorton
- Clinical Investigation Centre, Inserm 1413, University Hospital, Nantes, France.,Department of Pediatrics and Pediatric Emergency, University Hospital, Nantes, France
| | - Jeanne Simon-Pimmel
- Department of Pediatrics and Pediatric Emergency, University Hospital, Nantes, France
| | - Damien Masson
- Biochemistry Department, University Hospital, Nantes, France
| | - Elise Launay
- Clinical Investigation Centre, Inserm 1413, University Hospital, Nantes, France.,Department of Pediatrics and Pediatric Emergency, University Hospital, Nantes, France
| | - Christèle Gras-Le Guen
- Clinical Investigation Centre, Inserm 1413, University Hospital, Nantes, France.,Department of Pediatrics and Pediatric Emergency, University Hospital, Nantes, France
| | - Pauline Scherdel
- Clinical Investigation Centre, Inserm 1413, University Hospital, Nantes, France
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Kahouadji S, Salamin P, Praz L, Coiffier J, Frochaux V, Durif J, Pereira B, Arlettaz L, Oris C, Sapin V, Bouvier D. S100B Blood Level Determination for Early Management of Ski-Related Mild Traumatic Brain Injury: A Pilot Study. Front Neurol 2020; 11:856. [PMID: 32922357 PMCID: PMC7456809 DOI: 10.3389/fneur.2020.00856] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 07/07/2020] [Indexed: 11/22/2022] Open
Abstract
Background: Mild traumatic brain injury (mTBI) management in emergency departments is a complex process involving clinical evaluation, laboratory testing, and computerized tomography (CT) scanning. Protein S100B has proven to be a useful blood biomarker for early evaluation of mTBI, as it reduces the required CT scans by one-third. However, to date, the ability of S100B to identify positive abnormal findings in the CT scans of patients suffering from mTBI caused by ski practice has not been investigated. Thus, the primary aim of this study was to investigate the diagnostic performance of S100B as an mTBI management biomarker in patients with ski-related mTBI. Materials and Methods: One hundred and thirty adult mTBI patients presenting to the emergency department of Hôpital du Valais in Sion, Switzerland, with a Glasgow Coma Scale (GCS) score of 13–15 and clinical indication for a CT scan were included in the study. Blood samples for S100B measurement were collected from each patient and frozen in 3-hour post-injury intervals. CT scans were performed for all patients. Later, serum S100B levels were compared to CT scan findings in order to evaluate the biomarker's performance. Results: Of the 130 included cases of mTBI, 87 (70%) were related to ski practice. At the internationally established threshold of 0.1 μg/L, the receiver operating characteristic curve of S100B serum levels for prediction of abnormal CT scans showed 97% sensitivity, 11% specificity, and a 92% negative predictive value. Median S100B concentrations did not differ according to sex, age, or GCS score. Additionally, there was no significant difference between skiers and non-skiers. However, a statistically significant difference was found when comparing the median S100B concentrations of patients who suffered fractures or had polytrauma and those who did not suffer fractures. Conclusion: The performance of S100B in post-mTBI brain lesion screenings seems to be affected by peripheral lesions and/or ski practice. The lack of neurospecificity of the biomarker in this context does not allow unnecessary CT scans to be reduced by one-third as expected.
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Affiliation(s)
- Samy Kahouadji
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Pauline Salamin
- Department of Emergency Medicine, Valais Hospital, Sion, Switzerland
| | - Laurent Praz
- Department of Emergency Medicine, Valais Hospital, Sion, Switzerland
| | - Julien Coiffier
- Department of Emergency Medicine, Valais Hospital, Sion, Switzerland
| | - Vincent Frochaux
- Department of Emergency Medicine, Valais Hospital, Sion, Switzerland
| | - Julie Durif
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics Unit (DRCI), CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Lionel Arlettaz
- Department of Biology, ICH, Valais Hospital, Sion, Switzerland
| | - Charlotte Oris
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Clermont-Ferrand, France.,Université Clermont Auvergne, CNRS, INSERM, GReD, Clermont-Ferrand, France
| | - Vincent Sapin
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Clermont-Ferrand, France.,Université Clermont Auvergne, CNRS, INSERM, GReD, Clermont-Ferrand, France
| | - Damien Bouvier
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Clermont-Ferrand, France.,Université Clermont Auvergne, CNRS, INSERM, GReD, Clermont-Ferrand, France
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Interest of blood biomarkers to predict lesions in medical imaging in the context of mild traumatic brain injury. Clin Biochem 2020; 85:5-11. [PMID: 32781055 DOI: 10.1016/j.clinbiochem.2020.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 08/04/2020] [Accepted: 08/06/2020] [Indexed: 12/21/2022]
Abstract
Mild traumatic brain injury (mTBI) is one of the common causes of emergency department visits around the world. Up to 90% of injuries are classified as mTBI. Cranial computed tomography (CCT) is a standard diagnostic tool for adults with mTBI. Alternatively, children can be admitted for inpatient observation with CCT scans performed only on those with clinical deterioration. The use of blood biomarkers is a supplementary tool for identifying patients at risk of intracerebral lesions who may need imaging. This review provides a contemporary clinical and laboratory framework for blood biomarker testing in mTBI management. The S100B protein is used routinely in the management of mTBI in Europe together with clinical guidelines. Due to its excellent negative predictive value, S100B protein is an alternative choice to CCT scanning for mTBI management under considered, consensual and pragmatic use. In this review, we propose points to help clinicians and clinical pathologists use serum S100B protein in the clinical routine. A review of the literature on the different biomarkers (GFAP, UCH-L1, NF [H or L], tau, H-FABP, SNTF, NSE, miRNAs, MBP, β trace protein) is also conducted. Some of these other blood biomarkers, used alone (GFAP, UCH-L1) or in combination (GFAP + H-FABP ± S100B ± IL10) can improve the specificity of S100B.
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Significance and Diagnostic Accuracy of Early S100B Serum Concentration after Aneurysmal Subarachnoid Hemorrhage. J Clin Med 2020; 9:jcm9061746. [PMID: 32516898 PMCID: PMC7356310 DOI: 10.3390/jcm9061746] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 05/30/2020] [Accepted: 06/03/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Early brain injuries (EBI) are one of the most important causes of morbidity and mortality after subarachnoid hemorrhage. At admission, a third of patients are unconscious (spontaneously or sedated) and EBI consequences are not evaluable. To date, it is unclear who will still be comatose (with severe EBI) and who will recover (with less severe EBI) once the aneurysm is treated and sedation withdrawn. The objective of the present study was to determine the diagnostic accuracy of S100B levels at hospital admission to identify patients with severe neurological consequences of EBI. Methods: Patients were consecutively included in this prospective blinded observational study. A motor component of the Glasgow coma score under 6 on day 3 was used to define patients with severe neurological consequences of EBI. Results: A total of 81 patients were included: 25 patients were unconscious at admission, 68 were treated by coiling. On day 3, 12 patients had severe consequences of EBI. A maximal S100B value between admission and day 1 had an area under the receiver operating characteristic curve (AUC) of 86.7% to predict severe EBI consequences. In patients with impaired consciousness at admission, the AUC was 88.2%. Conclusion: Early S100B seems to have a good diagnostic value to predict severe EBI. Before claiming the usefulness of S100B as a surrogate marker of EBI severity to start earlier multimodal monitoring, these results must be confirmed in an independent validation cohort.
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Pflüger P, Eyer F. Wann besteht die Indikation für eine CCT bei intoxikierten Patienten? Notf Rett Med 2020. [DOI: 10.1007/s10049-019-00671-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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The utility of S100B level in detecting mild traumatic brain injury in intoxicated patients. Am J Emerg Med 2019; 38:799-805. [PMID: 31884023 DOI: 10.1016/j.ajem.2019.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 11/22/2019] [Accepted: 12/02/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND S100B is a serum protein known to elevate in patients with brain injury, but it is unknown whether it can predict intracranial pathology in intoxicated patients following mild traumatic brain injury (MTBI). We performed a systematic review and meta-analysis of the English language literature to address this question. MAIN OUTCOMES AND RESULTS Four prospective cohort trials of serum S100B levels on acutely intoxicated patients with MTBI were included in this meta-analysis. Prevalence of intracranial pathology in the pooled cohort of the intoxicated MTBI patients was 10%, lower than the 15-30% reported in the literature for the general MTBI population. Standard mean difference of serum S100B levels between patients with and without intracranial pathology on CT was 0.73 μg/L (Z = 18.33, P < 0.001). Following sensitivity analysis and hierarchical summary receiver-operating characteristic models, three remaining articles were used for pooled estimates that found that S100B had a sensitivity of 0.96 (95% CI: 0.84-1.00, I2 = 0%) and specificity of 0.63 (95% CI: 0.58-0.68, I2 = 86.8%) with a high negative predictive value (100%, 95% CI: 95.14-100, I2 = 0%) and a negative LR of 0.06 (95% CI: 0.01-0.31). CONCLUSIONS Serum S100B levels may have utility in ruling out intracranial pathology in intoxicated patients, however more study and comparison with other serum biomarkers of brain injury are necessary before this becomes the accepted standard of care.
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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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Bouvier D, Balayssac D, Durif J, Mourgues C, Sarret C, Pereira B, Sapin V. Assessment of the advantage of the serum S100B protein biomonitoring in the management of paediatric mild traumatic brain injury-PROS100B: protocol of a multicentre unblinded stepped wedge cluster randomised trial. BMJ Open 2019; 9:e027365. [PMID: 31129587 PMCID: PMC6537998 DOI: 10.1136/bmjopen-2018-027365] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION S100B serum analysis in clinical routine could reduce the number of cranial CT (CCT) scans performed on children with mild traumatic brain injury (mTBI). Sampling should take place within 3 hours of trauma and cut-off levels should be based on paediatric reference ranges. The aim of this study is to evaluate the utility of measuring serum S100B in the management of paediatric mTBI by demonstrating a decrease in the number of CCT scans prescribed in an S100B biomonitoring group compared with a 'conventional management' control group, with the assumption of a 30% relative decrease of the number of CCT scans between the two groups. METHODS AND ANALYSIS The protocol is a randomised, multicentre, unblinded, prospective, interventional study (nine centres) using a stepped wedge cluster design, comparing two groups (S100B biomonitoring and control). Children in the control group will have CCT scans or be hospitalised according to the current recommendations of the French Society of Paediatrics (SFP). In the S100B biomonitoring group, blood sampling to determine serum S100B protein levels will take place within 3 hours after mTBI and subsequent management will depend on the assay. If S100B is in the normal range according to age, the children will be discharged from the emergency department after 6 hours' observation. If the result is abnormal, CCT scans or hospitalisation will be prescribed in accordance with current SFP recommendations. The primary outcome measure will be the proportion of CCT scans performed (absence/presence of CCT scan for each patient) in the 48 hours following mTBI. ETHICS AND DISSEMINATION The protocol presented (Version 5, 03 November 2017) has been approved by the ethics committee Comité de Protection des Personnes sud-est 6 (first approval 08 June 2016, IRB: 00008526). Participation in the study is voluntary and anonymous. The study findings will be disseminated in international peer-reviewed journals and presented at relevant conferences. TRIAL REGISTRATION NUMBER NCT02819778.
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Affiliation(s)
- Damien Bouvier
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Université Clermont Auvergne, CNRS, INSERM, GReD, Clermont-Ferrand, France
| | - David Balayssac
- DRCI, CHU Clermont-Ferrand, Université Clermont-Auvergne, INSERM U1107, NEURO-DOL, Clermont-Ferrand, France
| | - Julie Durif
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Catherine Sarret
- Pediatric Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Bruno Pereira
- DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Vincent Sapin
- Biochemistry and Molecular Genetic Department, CHU Clermont-Ferrand, Université Clermont Auvergne, CNRS, INSERM, GReD, Clermont-Ferrand, France
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Rezaii PG, Grant GA, Zeineh MM, Richardson KJ, Coburn ML, Bet AM, Weber A, Jiang B, Li Y, Ubungen K, Routh G, Wheatcroft AM, Paulino AD, Hayes RL, Steinberg GK, Wintermark M. Stability of Blood Biomarkers of Traumatic Brain Injury. J Neurotrauma 2019; 36:2407-2416. [PMID: 30968744 DOI: 10.1089/neu.2018.6053] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Blood biomarker tests were recently approved for clinical diagnosis of traumatic brain injury (TBI), yet there are still fundamental questions that need attention. One such question is the stability of putative biomarkers in blood over the course of several days after injury if the sample is unable to be processed into serum or plasma and stored at low temperatures. Blood may not be able to be stored at ultra-low temperatures in austere combat or sports environments. In this prospective study of 20 adult patients with positive head computed tomography imaging findings, the stability of three biomarkers (glial fibrillary acidic protein [GFAP], ubiquitin C-terminal hydrolase-L1 [UCH-L1], and S100 calcium binding protein B [S100B]) in whole blood and in serum stored at 4-5°C was evaluated over the course of 72 h after blood collection. The amount of time whole blood and serum were refrigerated had no significant effect on GFAP concentration in plasma obtained from whole blood and in serum (p = 0.6256 and p = 0.3687, respectively), UCH-L1 concentration in plasma obtained from whole blood and in serum (p = 0.0611 and p = 0.5189, respectively), and S100B concentration in serum (p = 0.4663). Concentration levels of GFAP, UCH-L1, and S100B in blood collected from patients with TBI were found to be stable at 4-5°C for at least 3 days after blood draw. This study suggests that the levels of the three diagnostic markers above are still valid for diagnostic TBI tests if the sample is stored in 4-5°C refrigerated conditions.
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Affiliation(s)
| | | | | | | | - Maria Lynn Coburn
- 2Department of Neurosurgery, Stanford University, Stanford, California
| | - Anthony Marco Bet
- 2Department of Neurosurgery, Stanford University, Stanford, California
| | - Art Weber
- 4Banyan Biomarkers Inc., San Diego, California
| | - Bin Jiang
- 1Department of Radiology, Stanford University, Stanford, California
| | - Ying Li
- 1Department of Radiology, Stanford University, Stanford, California
| | - Kristine Ubungen
- 3Department of Anatomic Pathology and Clinical Laboratories, Stanford University, Stanford, California
| | - Gay Routh
- 3Department of Anatomic Pathology and Clinical Laboratories, Stanford University, Stanford, California
| | | | | | | | | | - Max Wintermark
- 1Department of Radiology, Stanford University, Stanford, California
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Abstract
Sports-related traumatic brain injuries (TBIs) range in severity from severe to subconcussive. Although technologies exist for clinical diagnosis of more severe injuries, methods for diagnosis of milder forms of brain injury are limited. Developing objective measures to indicate pathogenic processes after a suspected mild TBI is challenging for multiple reasons. The field of biomarker discovery for diagnosing TBI continues to expand, with newly identified candidate biomarkers being reported regularly. Brain-specific biomarkers include proteins derived from neurons and glia, and are often measured to assess neural injury and repair, and to predict outcomes. Ideally, changes in biomarker levels should indicate pathologic events and answer critical questions for accurate diagnosis and prognosis. For example, does the presence or a change in the biomarker level suggest greater vulnerability for sustaining a second concussion or show that the window of increased vulnerability has passed? Likewise, do changes in biomarker levels predict postconcussion syndrome or recovery/repair? Although there are numerous promising candidates for fluid biomarkers that may diagnose mild TBI or concussion, none has reached the clinic to date. In this chapter, we will define biomarkers, discuss the importance of understanding their normal and pathologic functions, and outline some considerations for interpreting detection assay results in TBI. We will then review five proposed blood and cerebrospinal fluid biomarkers (tau, neurofilament, ubiquitin carboxyl-terminal hydrolase L1, S100β, and glial fibrillary acidic protein) used currently to address TBI. Lastly, we will discuss a future trajectory for developing new, clinically useful fluid biomarkers.
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Abstract
S100B is a calcium-binding protein most abundant in neuronal tissue. It is expressed in glial cells and Schwann cells and exerts both intra- and extracellular effects. Depending on the concentration, secreted S100B exerts either trophic or toxic effects. Its functions have been extensively studied but are still not fully understood. It can be measured in cerebrospinal fluid and in blood, and increased S100B level in blood can be seen after, e.g., traumatic brain injury, certain neurodegenerative disorders, and malignant melanoma. This chapter provides a short background of protein S100B, commercially available methods of analysis, and its clinical use, especially as a biomarker in minor head injury.
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Affiliation(s)
- Ramona Astrand
- Department of Neurosurgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Johan Undén
- Department of Anaesthesia and Intensive Care, Länssjukhuset Halland, Halmstad, Sweden
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Ananthaharan A, Kravdal G, Straume-Naesheim TM. Utility and effectiveness of the Scandinavian guidelines to exclude computerized tomography scanning in mild traumatic brain injury - a prospective cohort study. BMC Emerg Med 2018; 18:44. [PMID: 30458714 PMCID: PMC6245911 DOI: 10.1186/s12873-018-0193-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 10/23/2018] [Indexed: 11/10/2022] Open
Abstract
Background In 2013 the Scandinavian Neurotrauma Committee (SNC) published updated guidelines for the initial management of minimal, mild and moderate traumatic head injuries (MTHI) that included serum analysis of protein S100B as a marker for brain tissue damage. This study reviews the effectiveness of the new guidelines in a clinical setting. Methods For all patients admitted to Akershus University Hospital (AHUS) from June 30th 2014 to December 15th 2014 with MTHI a separate form was filled in recording the time, indication and result of any S100B sampling and/or head computer tomography (CT) examinations. Data from these forms were compared to information derived from the electronic patient records for patients with MTHI and related diagnoses and data from the laboratory for all patients that had undergone the S100B analysis within the same period. Results Five hundred seventy-five patients were identified with MTHI, S100B sampling was indicated for 223 (38.8%) patients and carried out for 188 (84.3%) of these patients. 69 (36.7%) of the patients had a negative S100B test, but a head CT scan was still performed in 31 cases despite the negative S100B test. In total the guidelines were followed for 362 of 575 patients (63.0%). 180 (31.3%) of the MTHI cases were discharged without further observation or CT examinations, including 38 (21.1%) as a direct result of S100B testing. No re-admissions or missed initial traumatic brain injuries were observed. Conclusion The implementation of the updated SNC guidelines resulted in direct discharge of more than one third of the MTHI cases without further observation or CT examinations. One in five of these discharges was a direct result of S100B testing. However, compliance to the guidelines were poor and the guidelines were only followed in 40%. While this study showed benefits of implementing SNC guidelines to reduce the number of CT scans, additional training is needed for optimal use.
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Affiliation(s)
- Arurann Ananthaharan
- Akershus University Hospital, Lørenskog, Norway. .,St.Olavs Hospital, Trondheim, Norway.
| | - Gunnhild Kravdal
- Multidisciplinary Laboratory Medicine and Medical Biochemistry, Akershus University Hospital, Lørenskog, Norway
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Asken BM, Bauer RM, DeKosky ST, Houck ZM, Moreno CC, Jaffee MS, Weber AG, Clugston JR. Concussion Biomarkers Assessed in Collegiate Student-Athletes (BASICS) I: Normative study. Neurology 2018; 91:e2109-e2122. [PMID: 30404785 DOI: 10.1212/wnl.0000000000006613] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 08/09/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe variability in concussion biomarker concentrations collected from serum in a sample of healthy collegiate athletes, as well as report reliability metrics in a subsample of female athletes. METHODS In this observational cohort study, β-amyloid peptide 42 (Aβ42), total tau, S100 calcium binding protein B (S100B), ubiquitin carboxy-terminal hydrolyzing enzyme L1 (UCH-L1), glial fibrillary acidic protein, microtubule associated protein 2, and 2',3'-cyclic-nucleotide 3'-phosphodiesterase (CNPase) serum concentrations were measured in 415 (61% male, 40% white, aged 19.0 ± 1.2 years) nonconcussed collegiate athletes without recent exposure to head impacts. Standardized normative distributions are reported for each biomarker. We evaluated main effects (analyses of variance) of sex and race, reporting demographic-specific normative metrics when appropriate. In a subset of 31 female participants, test-retest reliability (Pearson r) and reliable change indices (80%, 90%, and 95% confidence intervals) across a 6- to 12-month interval are reported for Aβ42, total tau, S100B, and UCH-L1. RESULTS Males exhibited higher UCH-L1 (p < 0.001, Cohen d = 0.75) and S100B (p < 0.001, d = 0.56) than females, while females had higher CNPase (p < 0.001, d = 0.43). Regarding race, black participants had higher baseline levels of UCH-L1 (p < 0.001, d = 0.61) and S100B (p < 0.001, d = 1.1) than white participants. Conversely, white participants had higher baseline levels of Aβ42 (p = 0.005, d = 0.28) and CNPase (p < 0.001, d = 0.46). Test-retest reliability was generally poor, ranging from -0.02 to 0.40, and Aβ42 significantly increased from time 1 to time 2. CONCLUSION Healthy collegiate athletes express concussion-related serum biomarkers in variable concentrations. Accounting for demographic factors such as sex and race is essential. Evidence suggested poor reliability for serum biomarkers; however, understanding how other factors influence biomarker expression, as well as knowledge of reliable change metrics, may improve clinical interpretation and future study designs.
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Affiliation(s)
- Breton M Asken
- From the Departments of Clinical and Health Psychology (B.M.A., R.M.B., Z.M.H., C.C.M.), Neurology (R.M.B., S.T.D., M.S.J., J.R.C.), and Community Health and Family Medicine (J.R.C.), and University Athletic Association (J.R.C.), University of Florida, Gainesville; and Banyan Biomarkers, Inc. (A.G.W.), Alachua, FL.
| | - Russell M Bauer
- From the Departments of Clinical and Health Psychology (B.M.A., R.M.B., Z.M.H., C.C.M.), Neurology (R.M.B., S.T.D., M.S.J., J.R.C.), and Community Health and Family Medicine (J.R.C.), and University Athletic Association (J.R.C.), University of Florida, Gainesville; and Banyan Biomarkers, Inc. (A.G.W.), Alachua, FL
| | - Steven T DeKosky
- From the Departments of Clinical and Health Psychology (B.M.A., R.M.B., Z.M.H., C.C.M.), Neurology (R.M.B., S.T.D., M.S.J., J.R.C.), and Community Health and Family Medicine (J.R.C.), and University Athletic Association (J.R.C.), University of Florida, Gainesville; and Banyan Biomarkers, Inc. (A.G.W.), Alachua, FL
| | - Zachary M Houck
- From the Departments of Clinical and Health Psychology (B.M.A., R.M.B., Z.M.H., C.C.M.), Neurology (R.M.B., S.T.D., M.S.J., J.R.C.), and Community Health and Family Medicine (J.R.C.), and University Athletic Association (J.R.C.), University of Florida, Gainesville; and Banyan Biomarkers, Inc. (A.G.W.), Alachua, FL
| | - Charles C Moreno
- From the Departments of Clinical and Health Psychology (B.M.A., R.M.B., Z.M.H., C.C.M.), Neurology (R.M.B., S.T.D., M.S.J., J.R.C.), and Community Health and Family Medicine (J.R.C.), and University Athletic Association (J.R.C.), University of Florida, Gainesville; and Banyan Biomarkers, Inc. (A.G.W.), Alachua, FL
| | - Michael S Jaffee
- From the Departments of Clinical and Health Psychology (B.M.A., R.M.B., Z.M.H., C.C.M.), Neurology (R.M.B., S.T.D., M.S.J., J.R.C.), and Community Health and Family Medicine (J.R.C.), and University Athletic Association (J.R.C.), University of Florida, Gainesville; and Banyan Biomarkers, Inc. (A.G.W.), Alachua, FL
| | - Arthur G Weber
- From the Departments of Clinical and Health Psychology (B.M.A., R.M.B., Z.M.H., C.C.M.), Neurology (R.M.B., S.T.D., M.S.J., J.R.C.), and Community Health and Family Medicine (J.R.C.), and University Athletic Association (J.R.C.), University of Florida, Gainesville; and Banyan Biomarkers, Inc. (A.G.W.), Alachua, FL
| | - James R Clugston
- From the Departments of Clinical and Health Psychology (B.M.A., R.M.B., Z.M.H., C.C.M.), Neurology (R.M.B., S.T.D., M.S.J., J.R.C.), and Community Health and Family Medicine (J.R.C.), and University Athletic Association (J.R.C.), University of Florida, Gainesville; and Banyan Biomarkers, Inc. (A.G.W.), Alachua, FL
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Asken BM, Bauer RM, DeKosky ST, Svingos AM, Hromas G, Boone JK, DuBose DN, Hayes RL, Clugston JR. Concussion BASICS III. Neurology 2018; 91:e2133-e2143. [DOI: 10.1212/wnl.0000000000006617] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 07/23/2018] [Indexed: 01/12/2023] Open
Abstract
ObjectiveTo evaluate changes in serum biomarker concentrations (β-amyloid peptide 42 [Aβ42], total tau, ubiquitin carboxy-terminal hydrolyzing enzyme L1, S100 calcium binding protein B [S100B], glial fibrillary acidic protein [GFAP], microtubule associated protein 2 [MAP2], and 2′,3′-cyclic-nucleotide 3′-phosphodiesterase [CNPase]) after sport-related concussion (SRC) in a sample of collegiate athletes. Associations with clinical outcomes were also investigated.MethodsParticipants in this case-control study included 36 athletes (50% male, 61% white, aged 19.7 ± 1.0 years) with SRC. Twenty-nine also had baseline blood drawn, allowing for within-patient analyses of concentration changes. Between-group analyses incorporated 86 demographically matched controls (51% male, 63% white, aged 19.6 ± 1.1 years). Biomarker sensitivity/specificity for SRC vs controls and relative to standardized normative cutoffs was evaluated (receiver operating characteristics). We also analyzed associations between post-SRC clinical outcomes and both biomarker change from baseline and post-SRC concentrations.ResultsThe majority of blood samples had concentrations of GFAP, MAP2, and CNPase below limits of quantification. Within-patient analyses indicated elevated S100B after SRC (p = 0.003, 67% of patients elevated), especially for blood samples collected <4 hours post-SRC (88% of patients). Significant between-group differences were limited to blood draws <4 hours post-SRC: Aβ42 (81% of SRC > control median, area under the curve [AUC] = 0.75 [95% confidence interval 0.59–0.91]), total tau (75% SRC > control, AUC = 0.74 [0.56–0.79]), and S100B (88% SRC > control; AUC [specific to white race] = 0.82 [0.72–0.93]). Using standardized normative cutoffs (z > 1.0), specificity ranged from 79.1% to 89.3% while sensitivity was <70%. Biomarkers were not associated with clinical outcomes.ConclusionFor SRC, diagnostic accuracy of serum biomarkers appears best if blood is collected within a few hours. Accurate blood marker identification of SRC appears somewhat dependent on the “healthy” comparison. Additional research must evaluate whether physiologic changes in the absence of clinical changes, or vice versa, are relevant for concurrent or future neurologic health.Classification of evidenceThis study provides Class III evidence that certain serum biomarkers are elevated from baseline and higher than demographically matched controls after sport-related concussion.
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Use of Blood Biomarkers in the Assessment of Sports-Related Concussion-A Systematic Review in the Context of Their Biological Significance. Clin J Sport Med 2018; 28:561-571. [PMID: 29035978 DOI: 10.1097/jsm.0000000000000478] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To critically review current knowledge on the positive and negative predictive value of blood biomarkers for concussion; to illustrate the clinical and biological contexts that help evaluate the use of these markers in sport-related traumatic brain injuries (TBIs). METHODS This systematic review was performed in accordance with PRISMA guidelines. We reviewed the measurement, clinical utility, endpoint, and biological significance of blood biomarkers in concussion. RESULTS A total of 4352 publications were identified. Twenty-six articles relating to blood biomarkers were included in the review. Four common blood biomarkers, namely S100B, tau, neuron-specific enolase (NSE), and glial fibrillary acidic protein (GFAP), were examined. Overall, the studies showed S100B measurement and use, either acutely or at several time points, can distinguish injured from noninjured patients with an uncertain degree of utility in predicting mortality. At present, S100B has largely become an acceptable biomarker of TBI; however, studies have begun to highlight the need to incorporate clinical symptoms instead of S100B concentration in isolation on the basis of inconsistent results and lack of specificity across published studies. Further research is needed to evaluate and validate the use of tau, NSE, and GFAP as a diagnostic aid in the management of concussion and TBI. CONCLUSIONS At present, blood biomarkers have only a limited role in the evaluation and management of concussion. Although several biomarkers of brain injury have been identified, continued research is required. S100B holds promise as the most clinically useful diagnostic biomarker. Blood biomarkers, in combination with other clinical data, such as head computed tomography, would maximize the diagnostic accuracy. The methodological limitations evident in blood biomarker research results in the need for the clinical utility of blood biomarker use in concussion to be further explored.
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Allouchery G, Moustafa F, Roubin J, Pereira B, Schmidt J, Raconnat J, Pic D, Sapin V, Bouvier D. Clinical validation of S100B in the management of a mild traumatic brain injury: issues from an interventional cohort of 1449 adult patients. ACTA ACUST UNITED AC 2018; 56:1897-1904. [DOI: 10.1515/cclm-2018-0471] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/22/2018] [Indexed: 02/06/2023]
Abstract
Abstract
Background:
This study’s primary objective was to validate the routine use of S100B via a prospective study. The aim was a reduction of cranial computed tomography (CCT) scans by 30%. The secondary goal was to investigate the influence of age and associated risk factors on the reduction of CCT.
Methods:
S100B (sampling within 3 h postinjury) was used for patients with mild traumatic brain injury (mTBIs) presenting a medium risk of complications and requiring a CCT scan. Patients with negative S100B (S100B−) were discharged without a CCT scan.
Results:
Of the 1449 patients included in this study, 468 (32.3%) had S100B− with a sensitivity of 96.4% (95% CI: 87.5%–99.6%), a specificity of 33.4% (95% CI: 31%–36%) and a negative predictive value of 99.6% (95% CI: 98.5%–99.9%). No significant difference in serum levels or the S100B+ rate was observed if patients had retrograde amnesia (0.16 μg/L; 63.8%), loss of consciousness (0.13; 63.6%) or antiplatelet therapy (0.20; 77.9%). Significant differences were found between the S100B concentrations and S100B positivity rates in patients >65 years old and all the groups with patients <55 years old (18–25, 26–35, 36–45 and 46–55). From 18 to 65 years old (n=874), the specificity is 39.3% (95% CI: 36%–42.6%) compared to 18.7% (95% CI: 15.3%–22.3%) for patients >65 years old (n=504).
Conclusions:
The clinical use of S100B in mTBI management reduces the use of CCTs by approximately one-third; furthermore, the percentage of CCTs reduction is influenced by the age of the patient.
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Dickens AM, Posti JP, Takala RSK, Ala-Seppälä H, Mattila I, Coles JP, Frantzén J, Hutchinson PJ, Katila AJ, Kyllönen A, Maanpää HR, Newcombe V, Outtrim J, Tallus J, Carpenter KLH, Menon DK, Hyötyläinen T, Tenovuo O, Orešic M. Serum Metabolites Associated with Computed Tomography Findings after Traumatic Brain Injury. J Neurotrauma 2018; 35:2673-2683. [PMID: 29947291 DOI: 10.1089/neu.2017.5272] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
There is a need to rapidly detect patients with traumatic brain injury (TBI) who require head computed tomography (CT). Given the energy crisis in the brain following TBI, we hypothesized that serum metabolomics would be a useful tool for developing a set of biomarkers to determine the need for CT and to distinguish among different types of injuries observed. Logistical regression models using metabolite data from the discovery cohort (n = 144, Turku, Finland) were used to distinguish between patients with traumatic intracranial findings and those with negative findings on head CT. The resultant models were then tested in the validation cohort (n = 66, Cambridge, United Kingdom). The levels of glial fibrillary acidic protein and ubiquitin C-terminal hydrolase-L1 were also quantified in the serum from the same patients. Despite there being significant differences in the protein biomarkers in patients with TBI, the model that determined the need for a CT scan validated poorly (area under the curve [AUC] = 0.64: Cambridge patients). However, using a combination of six metabolites (two amino acids, three sugar derivatives, and one ketoacid) it was possible to discriminate patients with intracranial abnormalities on CT and patients with a normal CT (AUC = 0.77 in Turku patients and AUC = 0.73 in Cambridge patients). Further, a combination of three metabolites could distinguish between diffuse brain injuries and mass lesions (AUC = 0.87 in Turku patients and AUC = 0.68 in Cambridge patients). This study identifies a set of validated serum polar metabolites, which associate with the need for a CT scan. Additionally, serum metabolites can also predict the nature of the brain injury. These metabolite markers may prevent unnecessary CT scans, thus reducing the cost of diagnostics and radiation load.
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Affiliation(s)
- Alex M Dickens
- 1 Turku Centre for Biotechnology, University of Turku , Turku, Finland
| | - Jussi P Posti
- 2 Turku Brain Injury Centre, Turku University Hospital , Turku, Finland .,3 Department of Neurology, University of Turku , Turku, Finland .,4 Division of Clinical Neurosciences, Department of Neurosurgery, Turku University Hospital , Turku, Finland
| | - Riikka S K Takala
- 5 Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital and University of Turku , Turku, Finland
| | | | - Ismo Mattila
- 6 Steno Diabetes Center Copenhagen , Gentofte, Denmark
| | - Jonathan P Coles
- 7 Division of Anaesthesia, Department of Medicine, University of Cambridge , Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Janek Frantzén
- 2 Turku Brain Injury Centre, Turku University Hospital , Turku, Finland .,3 Department of Neurology, University of Turku , Turku, Finland .,4 Division of Clinical Neurosciences, Department of Neurosurgery, Turku University Hospital , Turku, Finland
| | - Peter J Hutchinson
- 8 Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge , Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Ari J Katila
- 5 Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital and University of Turku , Turku, Finland
| | - Anna Kyllönen
- 3 Department of Neurology, University of Turku , Turku, Finland
| | | | - Virginia Newcombe
- 7 Division of Anaesthesia, Department of Medicine, University of Cambridge , Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Joanne Outtrim
- 7 Division of Anaesthesia, Department of Medicine, University of Cambridge , Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Jussi Tallus
- 3 Department of Neurology, University of Turku , Turku, Finland
| | - Keri L H Carpenter
- 8 Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge , Addenbrooke's Hospital, Cambridge, United Kingdom
| | - David K Menon
- 7 Division of Anaesthesia, Department of Medicine, University of Cambridge , Addenbrooke's Hospital, Cambridge, United Kingdom
| | | | - Olli Tenovuo
- 2 Turku Brain Injury Centre, Turku University Hospital , Turku, Finland .,3 Department of Neurology, University of Turku , Turku, Finland
| | - Matej Orešic
- 1 Turku Centre for Biotechnology, University of Turku , Turku, Finland .,10 Schools of Medical Science, Örebro University , Örebro, Sweden
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