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Comparative Study
. 2012 May;72(5):1335-44.
doi: 10.1097/TA.0b013e3182491e3d.

Serum levels of ubiquitin C-terminal hydrolase distinguish mild traumatic brain injury from trauma controls and are elevated in mild and moderate traumatic brain injury patients with intracranial lesions and neurosurgical intervention

Linda Papa  1 , Lawrence M Lewis, Salvatore Silvestri, Jay L Falk, Philip Giordano, Gretchen M Brophy, Jason A Demery, Ming Cheng Liu, Jixiang Mo, Linnet Akinyi, Stefania Mondello, Kara Schmid, Claudia S Robertson, Frank C Tortella, Ronald L Hayes, Kevin K W Wang
Affiliations
Comparative Study

Serum levels of ubiquitin C-terminal hydrolase distinguish mild traumatic brain injury from trauma controls and are elevated in mild and moderate traumatic brain injury patients with intracranial lesions and neurosurgical intervention

Linda Papa et al. J Trauma Acute Care Surg. 2012 May.

Abstract

Background: This study compared early serum levels of ubiquitin C-terminal hydrolase (UCH-L1) from patients with mild and moderate traumatic brain injury (TBI) with uninjured and injured controls and examined their association with traumatic intracranial lesions on computed tomography (CT) scan (CT positive) and the need for neurosurgical intervention (NSI).

Methods: This prospective cohort study enrolled adult patients presenting to three tertiary care Level I trauma centers after blunt head trauma with loss of consciousness, amnesia, or disorientation and a Glasgow Coma Scale (GCS) score 9 to 15. Control groups included normal uninjured controls and nonhead injured trauma controls presenting to the emergency department with orthopedic injuries or motor vehicle crash without TBI. Blood samples were obtained in all trauma patients within 4 hours of injury and measured by enzyme-linked immunosorbent assay for UCH-L1 (ng/mL ± standard error of the mean).

Results: There were 295 patients enrolled, 96 TBI patients (86 with GCS score 13-15 and 10 with GCS score 9-12), and 199 controls (176 uninjured, 16 motor vehicle crash controls, and 7 orthopedic controls). The AUC for distinguishing TBI from uninjured controls was 0.87 (95% confidence interval [CI], 0.82-0.92) and for distinguishing those TBIs with GCS score 15 from controls was AUC 0.87 (95% CI, 0.81-0.93). Mean UCH-L1 levels in patients with CT negative versus CT positive were 0.620 (± 0.254) and 1.618 (± 0.474), respectively (p < 0.001), and the AUC was 0.73 (95% CI, 0.62-0.84). For patients without and with NSI, levels were 0.627 (0.218) versus 2.568 (0.854; p < 0.001), and the AUC was 0.85 (95% CI, 0.76-0.94).

Conclusion: UCH-L1 is detectable in serum within an hour of injury and is associated with measures of injury severity including the GCS score, CT lesions, and NSI. Further study is required to validate these findings before clinical application.

Level of evidence: II, prognostic study.

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Figures

Figure 1
Figure 1
Flow diagram of enrolled patients
Figure 2
Figure 2
a & b UCH-L1 Levels among the different GCS groups versus Control groups
Figure 3
Figure 3
a & b ROC Curve for distinguishing TBI patients versus Uninjured Controls
Figure 4
Figure 4
a, b, c & d Bar Graphs comparing serum UCH-L1 Levels in patients with and without traumatic intracranial lesions on CT in all TBI patients and the subgroup with GCS 15 AND an ROC Curve for distinguishing CT positive versus CT negative
Figure 5
Figure 5
a, b & c Bar Graph comparing serum UCH-L1 Levels in patients with and without neurosurgical intervention in all TBI patients and in those with GCS 15 only AND an ROC Curve for distinguishing patients with and without neurosurgical intervention
See this image and copyright information in PMC

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