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Castaño-Leon AM, Sánchez Carabias C, Hilario A, Ramos A, Navarro-Main B, Paredes I, Munarriz PM, Panero I, Eiriz Fernández C, García-Pérez D, Moreno-Gomez LM, Esteban-Sinovas O, Garcia Posadas G, Gomez PA, Lagares A. Serum assessment of traumatic axonal injury: the correlation of GFAP, t-Tau, UCH-L1, and NfL levels with diffusion tensor imaging metrics and its prognosis utility. J Neurosurg 2023; 138:454-464. [PMID: 35901687 DOI: 10.3171/2022.5.jns22638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/19/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Diagnosis of traumatic axonal injury (TAI) is challenging because of its underestimation by conventional MRI and the technical requirements associated with the processing of diffusion tensor imaging (DTI). Serum biomarkers seem to be able to identify patients with abnormal CT scanning findings, but their potential role to assess TAI has seldomly been explored. METHODS Patients with all severities of traumatic brain injury (TBI) were prospectively included in this study between 2016 and 2021. They underwent blood extraction within 24 hours after injury and imaging assessment, including DTI. Serum concentrations of glial fibrillary acidic protein, total microtubule-associated protein (t-Tau), ubiquitin C-terminal hydrolase L1 (UCH-L1), and neurofilament light chain (NfL) were measured using an ultrasensitive Simoa multiplex assay panel, a digital form of enzyme-linked immunosorbent assay. The Glasgow Outcome Scale-Extended score was determined at 6 months after TBI. The relationships between biomarker concentrations, volumetric analysis of corpus callosum (CC) lesions, and fractional anisotropy (FA) were analyzed by nonparametric tests. The prognostic utility of the biomarker was determined by calculating the C-statistic and an ordinal regression analysis. RESULTS A total of 87 patients were included. Concentrations of all biomarkers were significantly higher for patients compared with controls. Although the concentration of the biomarkers was affected by the presence of mass lesions, FA of the CC was an independent factor influencing levels of UCH-L1 and NfL, which positioned these two biomarkers as better surrogates of TAI. Biomarkers also performed well in determining patients who would have had unfavorable outcome. NfL and the FA of the CC are independent complementary factors related to outcome. CONCLUSIONS UCH-L1 and NfL seem to be the biomarkers more specific to detect TAI. The concentration of NfL combined with the FA of the CC might help predict long-term outcome.
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Affiliation(s)
- Ana M Castaño-Leon
- 1Department of Neurosurgery, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid
| | | | - Amaya Hilario
- 3Department of Radiology, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid
| | - Ana Ramos
- 3Department of Radiology, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid
| | - Blanca Navarro-Main
- 4Department of Psychiatry, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid; and
| | - Igor Paredes
- 1Department of Neurosurgery, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid
| | - Pablo M Munarriz
- 1Department of Neurosurgery, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid
| | - Irene Panero
- 1Department of Neurosurgery, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid
| | - Carla Eiriz Fernández
- 1Department of Neurosurgery, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid
| | - Daniel García-Pérez
- 1Department of Neurosurgery, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid
| | - Luis Miguel Moreno-Gomez
- 1Department of Neurosurgery, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid
| | - Olga Esteban-Sinovas
- 1Department of Neurosurgery, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid
| | - Guillermo Garcia Posadas
- 1Department of Neurosurgery, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid
| | - Pedro A Gomez
- 1Department of Neurosurgery, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid
| | - Alfonso Lagares
- 1Department of Neurosurgery, Research Institute i+12-CIBERESP, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid.,5Department of Surgery, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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Paredes I, Castaño Leon AM, Lagares A, Jimenez Roldan L, Perez-Nuñez A, González-Leon P, Delgado-Fernandez J, Eiriz C, García-Pérez D, Moreno-Gomez LM, Esteban-Sinovas O, Delgado-López P, Martín-Alonso J, Kaen A, Tirado-Caballero J, Ordóñez Carmona M, Arteaga Romero F, Gonzalez Pombo M, Alén JF, Gil-Simoes R, Torres CV, Navas Garcia M, Blasco G, Frade-Porto N, González-Tarno P, Martin Segura A, Gelabert-Gonzalez M, Menendez Cortezon B, Rodriguez Botana B, Pérez-Alfayate R, Fernandez Garcia C, Ferrandez Pujante B, Vargas-Jiménez A, Cotúa C, de la Lama A, Calero L, Ruiz-Juretschke F, Garcia Leal R, Valera Mele M, Casitas Hernando V, Rivero Martín B, Orduna J, Casado Pellejero J, Fustero De Miguel D, Diaz-Molina J, Moles Herbera J, Castello Ruiz MJ, Gomar Alba M, Garcia Perez F, Hernandez Garcia BJ, Villaseñor Ledezma J, Otero Rodríguez Á, Ailagas JJ, Goncalves-Estella J, Sousa Casasnovas P, Pascual Argente D, Ruiz Martín L, Roa Montes de Oca JC, Arandia Guzmán D, García Martín A, Torres Carretero L, Garrido Ruíz PA, Calvo M, Miranda-Lloret P, Rodriguez-Cadarso Suarez-Vence M, Anotn Oltra J, Roca Barber A, Quiroz Tejada A, Carbayo Lozano G, Bermudez Vilar G, Paternain Martin C, Dela FuenteVilla P, Fidalgo De la Rosa M, Sistiaga García ÍL, Zabalo San Juan G. Impact of the first wave of the SARS-CoV-2 pandemic on the outcome of neurosurgical patients: a nationwide study in Spain. BMJ Open 2021; 11:e053983. [PMID: 34893486 PMCID: PMC9065769 DOI: 10.1136/bmjopen-2021-053983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To assess the effect of the first wave of the SARS-CoV-2 pandemic on the outcome of neurosurgical patients in Spain. SETTINGS The initial flood of COVID-19 patients overwhelmed an unprepared healthcare system. Different measures were taken to deal with this overburden. The effect of these measures on neurosurgical patients, as well as the effect of COVID-19 itself, has not been thoroughly studied. PARTICIPANTS This was a multicentre, nationwide, observational retrospective study of patients who underwent any neurosurgical operation from March to July 2020. INTERVENTIONS An exploratory factorial analysis was performed to select the most relevant variables of the sample. PRIMARY AND SECONDARY OUTCOME MEASURES Univariate and multivariate analyses were performed to identify independent predictors of mortality and postoperative SARS-CoV-2 infection. RESULTS Sixteen hospitals registered 1677 operated patients. The overall mortality was 6.4%, and 2.9% (44 patients) suffered a perioperative SARS-CoV-2 infection. Of those infections, 24 were diagnosed postoperatively. Age (OR 1.05), perioperative SARS-CoV-2 infection (OR 4.7), community COVID-19 incidence (cases/105 people/week) (OR 1.006), postoperative neurological worsening (OR 5.9), postoperative need for airway support (OR 5.38), ASA grade ≥3 (OR 2.5) and preoperative GCS 3-8 (OR 2.82) were independently associated with mortality. For SARS-CoV-2 postoperative infection, screening swab test <72 hours preoperatively (OR 0.76), community COVID-19 incidence (cases/105 people/week) (OR 1.011), preoperative cognitive impairment (OR 2.784), postoperative sepsis (OR 3.807) and an absence of postoperative complications (OR 0.188) were independently associated. CONCLUSIONS Perioperative SARS-CoV-2 infection in neurosurgical patients was associated with an increase in mortality by almost fivefold. Community COVID-19 incidence (cases/105 people/week) was a statistically independent predictor of mortality. TRIAL REGISTRATION NUMBER CEIM 20/217.
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Affiliation(s)
- Igor Paredes
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Alfonso Lagares
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Luis Jimenez Roldan
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Angel Perez-Nuñez
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Pedro González-Leon
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Carla Eiriz
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Daniel García-Pérez
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | | | | | - Ariel Kaen
- Department of Neurosurgery, Virgen del Rocio University Hospital, Sevilla, Andalucía, Spain
| | | | - Marta Ordóñez Carmona
- Department of Neurosurgery, Virgen del Rocio University Hospital, Sevilla, Andalucía, Spain
| | | | - Marta Gonzalez Pombo
- Department of Neurosurgery, Virgen del Rocio University Hospital, Sevilla, Andalucía, Spain
| | - José F Alén
- Department of Neurosurgery, Hospital Universitario de la Princesa, Madrid, Spain
| | - Ricardo Gil-Simoes
- Department of Neurosurgery, Hospital Universitario de la Princesa, Madrid, Spain
| | - Cristina V Torres
- Department of Neurosurgery, Hospital Universitario de la Princesa, Madrid, Spain
| | - Marta Navas Garcia
- Department of Neurosurgery, Hospital Universitario de la Princesa, Madrid, Spain
| | - Guillermo Blasco
- Department of Neurosurgery, Hospital Universitario de la Princesa, Madrid, Spain
| | - Natalia Frade-Porto
- Department of Neurosurgery, Hospital Universitario de la Princesa, Madrid, Spain
| | | | - Adrian Martin Segura
- Department of Neurosurgery, Hospital Universitario de la Princesa, Madrid, Spain
| | - Miguel Gelabert-Gonzalez
- Department of Neurosurgery, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Galicia, Spain
| | - Beatriz Menendez Cortezon
- Department of Neurosurgery, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Galicia, Spain
| | - Brais Rodriguez Botana
- Department of Neurosurgery, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Galicia, Spain
| | - Rebeca Pérez-Alfayate
- Department of Neurosurgery, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | | | | | - Andres Vargas-Jiménez
- Department of Neurosurgery, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | - Carlos Cotúa
- Department of Neurosurgery, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | | | | | - Fernando Ruiz-Juretschke
- Department of Neurosurgery, Hospital General Universitario Gregorio Maranon, Madrid, Madrid, Spain
| | - Roberto Garcia Leal
- Department of Neurosurgery, Hospital General Universitario Gregorio Maranon, Madrid, Madrid, Spain
| | - Marc Valera Mele
- Department of Neurosurgery, Hospital General Universitario Gregorio Maranon, Madrid, Madrid, Spain
| | - Vicente Casitas Hernando
- Department of Neurosurgery, Hospital General Universitario Gregorio Maranon, Madrid, Madrid, Spain
| | - Belén Rivero Martín
- Department of Neurosurgery, Hospital Universitario del Niño Jesús, Madrid, Spain
| | - Javier Orduna
- Department of Neurosurgery, Hospital Universitario Miguel Servet, Zaragoza, Aragón, Spain
| | - Juan Casado Pellejero
- Department of Neurosurgery, Hospital Universitario Miguel Servet, Zaragoza, Aragón, Spain
| | | | - Jorge Diaz-Molina
- Department of Neurosurgery, Hospital Universitario Miguel Servet, Zaragoza, Aragón, Spain
| | - Jesus Moles Herbera
- Department of Neurosurgery, Hospital Universitario Miguel Servet, Zaragoza, Aragón, Spain
| | | | - Mario Gomar Alba
- Department of Neurosurgery, Hospital Universitario Torrecardenas, Almería, Spain
| | | | | | - Javier Villaseñor Ledezma
- Department of Neurosurgery, Complejo Asistencial Universitario de Salamanca, Salamanca, Castilla y Leon, Spain
| | - Álvaro Otero Rodríguez
- Department of Neurosurgery, Complejo Asistencial Universitario de Salamanca, Salamanca, Castilla y Leon, Spain
| | - Juan José Ailagas
- Department of Neurosurgery, Complejo Asistencial Universitario de Salamanca, Salamanca, Castilla y Leon, Spain
| | - Jesús Goncalves-Estella
- Department of Neurosurgery, Complejo Asistencial Universitario de Salamanca, Salamanca, Castilla y Leon, Spain
| | - Pablo Sousa Casasnovas
- Department of Neurosurgery, Complejo Asistencial Universitario de Salamanca, Salamanca, Castilla y Leon, Spain
| | - Daniel Pascual Argente
- Department of Neurosurgery, Complejo Asistencial Universitario de Salamanca, Salamanca, Castilla y Leon, Spain
| | - Laura Ruiz Martín
- Department of Neurosurgery, Complejo Asistencial Universitario de Salamanca, Salamanca, Castilla y Leon, Spain
| | | | - Daniel Arandia Guzmán
- Department of Neurosurgery, Complejo Asistencial Universitario de Salamanca, Salamanca, Castilla y Leon, Spain
| | - Andoni García Martín
- Department of Neurosurgery, Complejo Asistencial Universitario de Salamanca, Salamanca, Castilla y Leon, Spain
| | - Luis Torres Carretero
- Department of Neurosurgery, Complejo Asistencial Universitario de Salamanca, Salamanca, Castilla y Leon, Spain
| | | | - Marta Calvo
- Department of Neurosurgery, Ciudad Real General University Hospital, Ciudad Real, Castilla-La Mancha, Spain
| | - Pablo Miranda-Lloret
- Neurosurgical Department, La Fe University and Polytechnic Hospital, Valencia, Comunidad Valenciana, Spain
| | | | - Joan Anotn Oltra
- Neurosurgical Department, La Fe University and Polytechnic Hospital, Valencia, Comunidad Valenciana, Spain
| | - Amparo Roca Barber
- Neurosurgical Department, La Fe University and Polytechnic Hospital, Valencia, Comunidad Valenciana, Spain
| | - Arnold Quiroz Tejada
- Neurosurgical Department, La Fe University and Polytechnic Hospital, Valencia, Comunidad Valenciana, Spain
| | | | - Garazi Bermudez Vilar
- Department of Neurosurgery, Cruces University Hospital, Barakaldo, País Vasco, Spain
| | | | | | | | | | - Gorka Zabalo San Juan
- Department of Neurosurgery, Cruces University Hospital, Barakaldo, País Vasco, Spain
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