September 25, 2023

J Neurotrauma. 2023 Aug 30. doi: 10.1089/neu.2023.0039. Online ahead of print.


Traumatic brain injury (TBI) remains a major cause of morbidity and mortality among the pediatric population. However, timely diagnosis remains a complex task due to the lack of standardized methods that permit its accurate identification. The aim of this study was to determine if serum levels of brain injury biomarkers can be used as a diagnostic and prognostic tool in this pathology. This prospective, observational study collected and analyzed the serum concentration of neuronal injury biomarkers at enrollment, 24- and 48-hours post-injury, in 34 children ages 0-18 with pTBI and 19 healthy controls (HC). Biomarkers included Glial Fibrillary Acidic Protein (GFAP), Neurofilament Protein L (NfL), Ubiquitin-C-terminal Hydrolase (UCH-L1), S-100B, tau and tau phosphorylated at threonine 181 (p-tau181). Subjects were stratified by admission Glasgow Coma Scale score into two categories: A combined mild/moderate (GCS 9-15) and severe (GCS 3-8). GOS-E Peds was dichotomized into favorable (≤4) and unfavorable (≥5) and outcomes. Data were analyzed utilizing Prism 9 and R statistical software. The findings were as follows: 15 patients were stratified as severe TBI, and 19 as mild/moderate per GCS. All biomarkers measured at enrollment were elevated compared to HC. Serum levels for all biomarkers were significantly higher in the severe TBI group compared to HC at 0, 24, and 48 hours. GFAP, tau S100B, and p-tau181 had the ability to differentiate TBI severity in the mild/moderate group when measured at 0h post-injury. Tau serum levels were increased in the mild/moderate group at 24h. Additionally, NfL and p-tau181 showed increased serum levels at 48h in the aforementioned GCS category. Individual biomarker performance on predicting unfavorable outcomes were measured at 0, 24, and 48h across different GOS-E Peds time points, which was significant for p-tau181 at 0h at all time points, UCH-L1 at 0h at 6-9 months and 12 months, GFAP at 48h at 12 months, NfL at 0h at 12 months, tau at 0h at 12 months and S100B at 0h at 12 months. We concluded that traumatic brain injury leads to increased serum neuronal injury biomarkers during the first 0-48 hours post-injury. A biomarker panel measuring these proteins could aid in the early diagnosis of mild to moderate pTBI and may predict neurological outcomes across the injury spectrum.

PMID:37646421 | DOI:10.1089/neu.2023.0039