1
|
Toro C, Jain S, Sun S, Temkin N, Barber J, Manley G, Komisarow JM, Ohnuma T, Foreman B, Korley F, James ML, Laskowitz D, Vavilala MS, Hernandez A, Mathew JP, Markowitz AJ, Krishnamoorthy V. Association of Brain Injury Biomarkers and Circulatory Shock Following Moderate-Severe Traumatic Brain Injury: A TRACK-TBI Study. J Neurosurg Anesthesiol 2023; 35:284-291. [PMID: 34967764 PMCID: PMC9243189 DOI: 10.1097/ana.0000000000000828] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/19/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Early circulatory shock following traumatic brain injury (TBI) is a multifactorial process; however, the impact of brain injury biomarkers on the risk of shock has not been evaluated. We examined the association between neuronal injury biomarker levels and the development of circulatory shock following moderate-severe TBI. METHODS In this retrospective cohort study, we examined adults with moderate-severe TBI (Glasgow Coma Scale score <13) enrolled in the TRACK-TBI study, an 18-center prospective TBI cohort study. The exposures were day-1 levels of neuronal injury biomarkers (glial fibrillary acidic protein, ubiquitin C-terminal hydrolase-L1 [UCH-L1], S100 calcium-binding protein B [S100B], neuron-specific enolase), and of an inflammatory biomarker (high-sensitivity C-reactive protein). The primary outcome was the development of circulatory shock, defined as cardiovascular Sequential Organ Failure Assessment Score ≥2 within 72 hours of admission. Association between day-1 biomarker levels and the development of circulatory shock was assessed with regression analysis. RESULTS The study included 392 subjects, with a mean age of 40 years; 314 (80%) were male and 165 (42%) developed circulatory shock. Median (interquartile range) day-1 levels of UCH-L1 (994.8 [518.7 to 1988.2] pg/mL vs. 548.1 [280.2 to 1151.9] pg/mL; P <0.0001) and S100B (0.47 μg/mL [0.25 to 0.88] vs. 0.27 [0.16 to 0.46] μg/mL; P <0.0001) were elevated in those who developed early circulatory shock compared with those who did not. In multivariable regression, there were associations between levels of both UCH-L1 (odds ratio, 1.63 [95% confidence interval, 1.25-2.12]; P <0.0005) and S100B (odds ratio, 1.73 [95% confidence interval 1.27-2.36]; P <0.0005) with the development of circulatory shock. CONCLUSION Neuronal injury biomarkers may provide the improved mechanistic understanding and possibly early identification of patients at risk for early circulatory shock following moderate-severe TBI.
Collapse
Affiliation(s)
- Camilo Toro
- Duke University School of Medicine. Durham, NC
| | - Sonia Jain
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego. San Diego, CA
| | - Shelly Sun
- Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego. San Diego, CA
| | - Nancy Temkin
- Department of Biostatistics, Anesthesiology and Pain Medicine, University of Washington. Seattle, WA
- Department of Neurosurgery, Anesthesiology and Pain Medicine, University of Washington. Seattle, WA
| | - Jason Barber
- Department of Neurosurgery, Anesthesiology and Pain Medicine, University of Washington. Seattle, WA
| | - Geoffrey Manley
- Brain and Spinal Injury Center, University of California, San Francisco. San Francisco, CA
| | | | - Tetsu Ohnuma
- Department of Anesthesiology, Duke University. Durham, NC
- Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University. Durham, NC
| | - Brandon Foreman
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati. Cincinnati, OH
| | - Frederick Korley
- Department of Emergency Medicine, University of Michigan. Ann Arbor, MI
| | - Michael L. James
- Department of Anesthesiology, Duke University. Durham, NC
- Department of Neurology, Duke University. Durham, NC
| | - Daniel Laskowitz
- Department of Anesthesiology, Duke University. Durham, NC
- Department of Neurology, Duke University. Durham, NC
| | - Monica S. Vavilala
- Department of Anesthesiology and Pain Medicine, and Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA
| | | | | | - Amy J. Markowitz
- Brain and Spinal Injury Center, University of California, San Francisco. San Francisco, CA
| | - Vijay Krishnamoorthy
- Department of Anesthesiology, Duke University. Durham, NC
- Department of Population Health Sciences, Duke University. Durham, NC
- Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University. Durham, NC
| | | |
Collapse
|
2
|
Stein MB, Jain S, Parodi L, Choi KW, Maihofer AX, Nelson LD, Mukherjee P, Sun X, He F, Okonkwo DO, Giacino JT, Korley FK, Vassar MJ, Robertson CS, McCrea MA, Temkin N, Markowitz AJ, Diaz-Arrastia R, Rosand J, Manley GT, Duhaime AC, Ferguson AR, Gopinath S, Grandhi R, Madden C, Merchant R, Schnyer D, Taylor SR, Yue JK, Zafonte R. Polygenic risk for mental disorders as predictors of posttraumatic stress disorder after mild traumatic brain injury. Transl Psychiatry 2023; 13:24. [PMID: 36693822 PMCID: PMC9873804 DOI: 10.1038/s41398-023-02313-9] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/03/2023] [Accepted: 01/06/2023] [Indexed: 01/26/2023] Open
Abstract
Many patients with mild traumatic brain injury (mTBI) are at risk for mental health problems such as posttraumatic stress disorder (PTSD). The objective of this study was to determine whether the polygenic risk for PTSD (or for related mental health disorders or traits including major depressive disorder [MDD] and neuroticism [NEU]) was associated with an increased likelihood of PTSD in the aftermath of mTBI. We used data from individuals of European ancestry with mTBI enrolled in TRACK-TBI (n = 714), a prospective longitudinal study of level 1 trauma center patients. One hundred and sixteen mTBI patients (16.3%) had probable PTSD (PCL-5 score ≥33) at 6 months post-injury. We used summary statistics from recent GWAS studies of PTSD, MDD, and NEU to generate polygenic risk scores (PRS) for individuals in our sample. A multivariable model that included age, sex, pre-injury history of mental disorder, and cause of injury explained 7% of the variance in the PTSD outcome; the addition of the PTSD-PRS (and five ancestral principal components) significantly increased the variance explained to 11%. The adjusted odds of PTSD in the uppermost PTSD-PRS quintile was nearly four times higher (aOR = 3.71, 95% CI 1.80-7.65) than in the lowest PTSD-PRS quintile. There was no evidence of a statistically significant interaction between PTSD-PRS and prior history of mental disorder, indicating that PTSD-PRS had similar predictive utility among those with and without pre-injury psychiatric illness. When added to the model, neither MDD-PRS nor NEU-PRS were significantly associated with the PTSD outcome. These findings show that the risk for PTSD in the context of mTBI is, in part, genetically influenced. They also raise the possibility that an individual's PRS could be clinically actionable if used-possibly with other non-genetic predictors-to signal the need for enhanced follow-up and early intervention; this precision medicine approach needs to be prospectively studied.
Collapse
Affiliation(s)
- Murray B. Stein
- grid.266100.30000 0001 2107 4242Department of Psychiatry, University of California, San Diego, La Jolla, CA USA ,grid.266100.30000 0001 2107 4242School of Public Health, University of California, San Diego, La Jolla, CA USA ,grid.410371.00000 0004 0419 2708VA San Diego Healthcare System, San Diego, CA USA
| | - Sonia Jain
- grid.266100.30000 0001 2107 4242Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA USA
| | - Livia Parodi
- grid.32224.350000 0004 0386 9924Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA USA ,grid.32224.350000 0004 0386 9924McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA USA ,grid.66859.340000 0004 0546 1623Broad Institute of MIT and Harvard, Cambridge, MA USA
| | - Karmel W. Choi
- grid.66859.340000 0004 0546 1623Broad Institute of MIT and Harvard, Cambridge, MA USA ,grid.32224.350000 0004 0386 9924Department of Psychiatry, Massachusetts General Hospital, Boston, MA USA
| | - Adam X. Maihofer
- grid.266100.30000 0001 2107 4242Department of Psychiatry, University of California, San Diego, La Jolla, CA USA
| | - Lindsay D. Nelson
- grid.30760.320000 0001 2111 8460Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, WI USA
| | - Pratik Mukherjee
- grid.266102.10000 0001 2297 6811Department of Radiology & Biomedical Imaging, UCSF, San Francisco, CA USA ,grid.266102.10000 0001 2297 6811Department of Bioengineering & Therapeutic Sciences, UCSF, San Francisco, CA USA
| | - Xiaoying Sun
- grid.266100.30000 0001 2107 4242Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA USA
| | - Feng He
- grid.266100.30000 0001 2107 4242Biostatistics Research Center, Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA USA
| | - David O. Okonkwo
- grid.412689.00000 0001 0650 7433Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA USA
| | - Joseph T. Giacino
- grid.38142.3c000000041936754XDepartment of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA USA ,grid.416228.b0000 0004 0451 8771Spaulding Rehabilitation Hospital, Charlestown, MA USA
| | - Frederick K. Korley
- grid.214458.e0000000086837370Department of Emergency Medicine, University of Michigan, Ann Arbor, MI USA
| | - Mary J. Vassar
- grid.416732.50000 0001 2348 2960Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA USA ,grid.266102.10000 0001 2297 6811Department of Neurological Surgery, UCSF, San Francisco, CA USA
| | - Claudia S. Robertson
- grid.39382.330000 0001 2160 926XDepartment of Neurosurgery, Baylor College of Medicine, Houston, TX USA
| | - Michael A. McCrea
- grid.30760.320000 0001 2111 8460Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, WI USA
| | - Nancy Temkin
- grid.34477.330000000122986657Departments of Neurological Surgery and Biostatistics, University of Washington, Seattle, WA USA
| | - Amy J. Markowitz
- grid.416732.50000 0001 2348 2960Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA USA
| | - Ramon Diaz-Arrastia
- grid.25879.310000 0004 1936 8972Department of Neurology, University of Pennsylvania, Philadelphia, PA USA
| | - Jonathan Rosand
- grid.32224.350000 0004 0386 9924Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA USA ,grid.32224.350000 0004 0386 9924McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA USA ,grid.66859.340000 0004 0546 1623Broad Institute of MIT and Harvard, Cambridge, MA USA
| | - Geoffrey T. Manley
- grid.416732.50000 0001 2348 2960Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA USA ,grid.266102.10000 0001 2297 6811Department of Neurological Surgery, UCSF, San Francisco, CA USA
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Palacios EM, Owen JP, Yuh EL, Wang MB, Vassar MJ, Ferguson AR, Diaz-Arrastia R, Giacino JT, Okonkwo DO, Robertson CS, Stein MB, Temkin N, Jain S, McCrea M, MacDonald CL, Levin HS, Manley GT, Mukherjee P. The evolution of white matter microstructural changes after mild traumatic brain injury: A longitudinal DTI and NODDI study. Sci Adv 2020; 6:eaaz6892. [PMID: 32821816 PMCID: PMC7413733 DOI: 10.1126/sciadv.aaz6892] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 06/26/2020] [Indexed: 05/11/2023]
Abstract
Neuroimaging biomarkers that can detect white matter (WM) pathology after mild traumatic brain injury (mTBI) and predict long-term outcome are needed to improve care and develop therapies. We used diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI) to investigate WM microstructure cross-sectionally and longitudinally after mTBI and correlate these with neuropsychological performance. Cross-sectionally, early decreases of fractional anisotropy and increases of mean diffusivity corresponded to WM regions with elevated free water fraction on NODDI. This elevated free water was more extensive in the patient subgroup reporting more early postconcussive symptoms. The longer-term longitudinal WM changes consisted of declining neurite density on NODDI, suggesting axonal degeneration from diffuse axonal injury for which NODDI is more sensitive than DTI. Therefore, NODDI is a more sensitive and specific biomarker than DTI for WM microstructural changes due to mTBI that merits further study for mTBI diagnosis, prognosis, and treatment monitoring.
Collapse
Affiliation(s)
- E. M. Palacios
- Department of Radiology & Biomedical Imaging, UCSF, San Francisco, CA, USA
| | - J. P. Owen
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - E. L. Yuh
- Department of Radiology & Biomedical Imaging, UCSF, San Francisco, CA, USA
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
| | - M. B. Wang
- Department of Radiology & Biomedical Imaging, UCSF, San Francisco, CA, USA
| | - M. J. Vassar
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
- Department of Neurological Surgery, UCSF, San Francisco, CA, USA
| | - A. R. Ferguson
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
- Department of Neurological Surgery, UCSF, San Francisco, CA, USA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - R. Diaz-Arrastia
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - J. T. Giacino
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - D. O. Okonkwo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - C. S. Robertson
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - M. B. Stein
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Department of Family Medicine & Public Health, University of California, San Diego, La Jolla, CA, USA
| | - N. Temkin
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - S. Jain
- Department of Family Medicine & Public Health, University of California, San Diego, La Jolla, CA, USA
| | - M. McCrea
- Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - C. L. MacDonald
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - H. S. Levin
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - G. T. Manley
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
- Department of Neurological Surgery, UCSF, San Francisco, CA, USA
| | - P. Mukherjee
- Department of Radiology & Biomedical Imaging, UCSF, San Francisco, CA, USA
- Brain and Spinal Cord Injury Center, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, San Francisco, CA, USA
- Corresponding author.
| | | |
Collapse
|
4
|
Zahniser E, Temkin NR, Machamer J, Barber J, Manley GT, Markowitz AJ, Dikmen SS. The Functional Status Examination in Mild Traumatic Brain Injury: A TRACK-TBI Sub-Study. Arch Clin Neuropsychol 2019; 34:1165-1174. [PMID: 30608522 PMCID: PMC10576412 DOI: 10.1093/arclin/acy103] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 08/11/2018] [Accepted: 12/26/2018] [Indexed: 08/06/2023] Open
Abstract
OBJECTIVE The Functional Status Examination (FSE) is a comprehensive measure of functional status post-traumatic brain injury (TBI) that has primarily been used in studies of moderate-to-severe TBI. The present observational study examines functional status using the FSE among patients who sustained mild TBIs (mTBIs; defined as Glasgow Coma Scale [GCS] = 13-15 at admission) seen in a Level 1 trauma center. Study aims included examining the course of functional status following mTBI, as well as exploring relationships of the FSE and other relevant constructs among those with GCS = 13-15. METHOD Participants were assessed at 2 weeks (n = 112), 3 months (n = 113), 6 months (n = 106), and 12 months (n = 88) post-injury for changes in functional status resulting both (a) from all injuries and (b) from TBI only. RESULTS Among seven domains of day-to-day functioning, participants generally experienced the greatest disruption in their primary activity (work or school) and in leisure and recreation. Subjects' overall functional status tended to improve over time, with sharpest increases in functionality occurring in the first 3 months post-injury. However, some subjects continued to report functional limitations even at 12 months post-injury. Functional status was largely unrelated to neurocognitive functioning, but related strongly to post-traumatic symptoms, life satisfaction, and emotional well-being, particularly at 3 months post-injury and beyond. CONCLUSION Findings indicate that functional impairments related to mTBI may be more likely to persist than widely believed, with those who experience lingering functional deficits at particular risk for emotional health difficulties.
Collapse
Affiliation(s)
- Evan Zahniser
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Nancy R Temkin
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Joan Machamer
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Jason Barber
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Geoffrey T Manley
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Amy J Markowitz
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Sureyya S Dikmen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | | |
Collapse
|
5
|
Wickwire EM, Albrecht JS, Griffin NR, Schnyer DM, Yue JK, Markowitz AJ, Okonkwo DO, Valadka AB, Badjatia N, Manley GT. Sleep disturbances precede depressive symptomatology following traumatic brain injury. Curr Neurobiol 2019; 10:49-55. [PMID: 34040318 PMCID: PMC8148630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The purpose of the present study was to evaluate the impact of sleep disturbances on subsequent depressive symptomatology among a representative sample of patients following traumatic brain injury (TBI). Within a retrospective cohort design, our sample included 305 individuals from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot (TRACK-TBI Pilot; NINDS-OD09-004) database. At 3-months post-TBI, symptoms of insomnia were reported by 34% of patients, and symptoms of hypersomnia were reported by 39% of patients. For the vast majority of individuals, sleep complaints were likely to persist through 6-month follow-up. Symptoms of hypersomnia but not insomnia at three months were associated with worsened depressive symptomatology at six months. These results highlight the importance of sleep disturbances in recovery from TBI and suggest targeted sleep treatments as a pathway to improve outcomes and quality of life following TBI.
Collapse
Affiliation(s)
- Emerson M. Wickwire
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
- Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Jennifer S. Albrecht
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
| | | | | | - John K. Yue
- Department of Neurosurgery, University of California, San Francisco, School of Medicine
| | - Amy J. Markowitz
- Department of Neurosurgery, University of California, San Francisco, School of Medicine
| | - David O. Okonkwo
- Department of Neurosurgery, University of Pittsburgh School of Medicine
| | - Alex B. Valadka
- Department of Neurosurgery, Virginia Commonwealth University School of Medicine
| | - Neeraj Badjatia
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
| | - Geoffrey T. Manley
- Department of Neurosurgery, University of California, San Francisco, School of Medicine
| | | |
Collapse
|
6
|
Gardner RC, Huie R, Ferguson A, Yaffe K, Manley GT. P1-304: COGNITIVE DECLINE ONE YEAR AFTER MILD TRAUMATIC BRAIN INJURY: A TRACK-TBI STUDY. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | | | | | - Kristine Yaffe
- University of California San Francisco / San Francisco VA Medical Center; San Francisco CA USA
| | | | | |
Collapse
|
7
|
Gardner RC, Nelson LD, Yue JK, Valadka AB, McCrea MA, Giacino JT, Manley GT. F5‐06‐01: EARLY COGNITIVE DECLINE WITHIN ONE YEAR AFTER TRAUMATIC BRAIN INJURY: A TRACK‐TBI STUDY. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.2988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Raquel C. Gardner
- University of California San Francisco/San Francisco VA Medical CenterSan FranciscoCAUSA
| | | | | | | | | | | | | | | |
Collapse
|
8
|
Nielson JL, Cooper SR, Yue JK, Sorani MD, Inoue T, Yuh EL, Mukherjee P, Petrossian TC, Paquette J, Lum PY, Carlsson GE, Vassar MJ, Lingsma HF, Gordon WA, Valadka AB, Okonkwo DO, Manley GT, Ferguson AR. Uncovering precision phenotype-biomarker associations in traumatic brain injury using topological data analysis. PLoS One 2017; 12:e0169490. [PMID: 28257413 PMCID: PMC5336356 DOI: 10.1371/journal.pone.0169490] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 12/16/2016] [Indexed: 12/13/2022] Open
Abstract
Background Traumatic brain injury (TBI) is a complex disorder that is traditionally stratified based on clinical signs and symptoms. Recent imaging and molecular biomarker innovations provide unprecedented opportunities for improved TBI precision medicine, incorporating patho-anatomical and molecular mechanisms. Complete integration of these diverse data for TBI diagnosis and patient stratification remains an unmet challenge. Methods and findings The Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) Pilot multicenter study enrolled 586 acute TBI patients and collected diverse common data elements (TBI-CDEs) across the study population, including imaging, genetics, and clinical outcomes. We then applied topology-based data-driven discovery to identify natural subgroups of patients, based on the TBI-CDEs collected. Our hypothesis was two-fold: 1) A machine learning tool known as topological data analysis (TDA) would reveal data-driven patterns in patient outcomes to identify candidate biomarkers of recovery, and 2) TDA-identified biomarkers would significantly predict patient outcome recovery after TBI using more traditional methods of univariate statistical tests. TDA algorithms organized and mapped the data of TBI patients in multidimensional space, identifying a subset of mild TBI patients with a specific multivariate phenotype associated with unfavorable outcome at 3 and 6 months after injury. Further analyses revealed that this patient subset had high rates of post-traumatic stress disorder (PTSD), and enrichment in several distinct genetic polymorphisms associated with cellular responses to stress and DNA damage (PARP1), and in striatal dopamine processing (ANKK1, COMT, DRD2). Conclusions TDA identified a unique diagnostic subgroup of patients with unfavorable outcome after mild TBI that were significantly predicted by the presence of specific genetic polymorphisms. Machine learning methods such as TDA may provide a robust method for patient stratification and treatment planning targeting identified biomarkers in future clinical trials in TBI patients. Trial Registration ClinicalTrials.gov Identifier NCT01565551
Collapse
MESH Headings
- Adult
- Biomarkers
- Brain Injuries, Traumatic/diagnosis
- Brain Injuries, Traumatic/diagnostic imaging
- Brain Injuries, Traumatic/genetics
- Brain Injuries, Traumatic/physiopathology
- Catechol O-Methyltransferase/genetics
- Female
- Humans
- Machine Learning
- Male
- Middle Aged
- Poly (ADP-Ribose) Polymerase-1/genetics
- Polymorphism, Single Nucleotide
- Protein Serine-Threonine Kinases/genetics
- Receptors, Dopamine D2/genetics
- Stress Disorders, Post-Traumatic/diagnosis
- Stress Disorders, Post-Traumatic/diagnostic imaging
- Stress Disorders, Post-Traumatic/genetics
- Stress Disorders, Post-Traumatic/physiopathology
Collapse
Affiliation(s)
- Jessica L. Nielson
- Brain and Spinal Injury Center (BASIC), Zuckerberg San Francisco General Hospital, San Francisco, CA, United States of America
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA
| | - Shelly R. Cooper
- Brain and Spinal Injury Center (BASIC), Zuckerberg San Francisco General Hospital, San Francisco, CA, United States of America
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States of America
| | - John K. Yue
- Brain and Spinal Injury Center (BASIC), Zuckerberg San Francisco General Hospital, San Francisco, CA, United States of America
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA
| | - Marco D. Sorani
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA
| | - Tomoo Inoue
- Brain and Spinal Injury Center (BASIC), Zuckerberg San Francisco General Hospital, San Francisco, CA, United States of America
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA
| | - Esther L. Yuh
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States of America
| | - Pratik Mukherjee
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States of America
| | | | | | - Pek Y. Lum
- Ayasdi, Inc, Palo Alto, CA, United States of America
| | | | - Mary J. Vassar
- Brain and Spinal Injury Center (BASIC), Zuckerberg San Francisco General Hospital, San Francisco, CA, United States of America
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA
| | | | - Wayne A. Gordon
- Department of Rehabilitation Medicine, Icahn School of Medicine, Mount Sinai, New York, NY, United States of America
| | - Alex B. Valadka
- Department of Neurosurgery, Virginia Commonwealth University, Richmond, VA, United States of America
| | - David O. Okonkwo
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Geoffrey T. Manley
- Brain and Spinal Injury Center (BASIC), Zuckerberg San Francisco General Hospital, San Francisco, CA, United States of America
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA
- * E-mail: (ARF); (GTM)
| | - Adam R. Ferguson
- Brain and Spinal Injury Center (BASIC), Zuckerberg San Francisco General Hospital, San Francisco, CA, United States of America
- Department of Neurological Surgery, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA
- Department of Veterans Affairs, San Francisco VA Medical Center, San Francisco, CA, United States of America
- * E-mail: (ARF); (GTM)
| | | |
Collapse
|