TY  - INPR
UR  - http://dx.doi.org/10.1136/emermed-2020-209471
A1  - Koivikko, P
A1  - Posti, JP
A1  - Mohammadian, M
A1  - Lagerstedt, L
A1  - Azurmendi, L
A1  - Hossain, I
A1  - Katila, AJ
A1  - Menon, D
A1  - Newcombe, VFJ
A1  - Hutchinson, PJ
A1  - Maanpaa, H-R
A1  - Tallus, J
A1  - Zetterberg, H
A1  - Blennow, K
A1  - Tenovuo, O
A1  - Sanchez, J-C
A1  - Takala, RSK
EP  - 7
AV  - public
JF  - Emergency Medicine Journal
N2  - Background: There is substantial interest in blood biomarkers as fast and objective diagnostic tools for traumatic brain injury (TBI) in the acute setting.

Methods: Adult patients (?18) with TBI of any severity and indications for CT scanning and orthopaedic injury controls were prospectively recruited during 2011?2013 at Turku University Hospital, Finland. The severity of TBI was classified with GCS: GCS 13?15 was classified as mild (mTBI); GCS 9?12 as moderate (moTBI) and GCS 3?8 as severe (sTBI). Serum samples were collected within 24?hours of admission and biomarker levels analysed with high-performance kits. The ability of biomarkers to distinguish between severity of TBI and CT-positive and CT-negative patients was assessed.

Results: Among 189 patients recruited, neurofilament light (NF-L) was obtained from 175 patients with TBI and 40 controls. S100 calcium-binding protein B (S100B), heart fatty-acid binding protein (H-FABP) and interleukin-10 (IL-10) were analysed for 184 patients with TBI and 39 controls. There were statistically significant differences between levels of all biomarkers between the severity classes, but none of the biomarkers distinguished patients with moTBI from patients with sTBI. Patients with mTBI discharged from the ED had lower levels of IL-10 (0.26, IQR=0.21, 0.39?pg/mL), H-FABP (4.15, IQR=2.72, 5.83?ng/mL) and NF-L (8.6, IQR=6.35, 15.98?pg/mL) compared with those admitted to the neurosurgical ward, IL-10 (0.55, IQR=0.31, 1.42?pg/mL), H-FABP (6.022, IQR=4.19, 20.72?ng/mL) and NF-L (13.95, IQR=8.33, 19.93?pg/mL). We observed higher levels of H-FABP and NF-L in older patients with mTBI. None of the biomarkers or their combinations was able to distinguish CT-positive (n=36) or CT-negative (n=58) patients with mTBI from controls.

Conclusions: S100B, H-FABP, NF-L and IL-10 levels in patients with mTBI were significantly lower than in patients with moTBI and sTBI but alone or in combination, were unable to distinguish patients with mTBI from orthopaedic controls. This suggests these biomarkers cannot be used alone to diagnose mTBI in trauma patients in the acute setting.

Data availability statement:
Data are available on reasonable request. De-identified clinical, imaging and biochemical data not published within the article can be shared with a qualified investigator by request.
KW  - Science & Technology
KW  -  Life Sciences & Biomedicine
KW  -  Emergency Medicine
KW  -  assessment
KW  -  acute care
KW  -  BIOMARKERS
KW  -  FLUID
ID  - discovery10141636
PB  - BMJ PUBLISHING GROUP
N1  - This version is the author accepted manuscript. For information on re-use, please refer to the publisher?s terms and conditions.
TI  - Potential of heart fatty-acid binding protein, neurofilament light, interleukin-10 and S100 calcium-binding protein B in the acute diagnostics and severity assessment of traumatic brain injury
Y1  - 2021/12/15/
ER  -