Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Oct 24;17(1):164.
doi: 10.1186/s12245-024-00708-z.

Evaluation of GFAP/UCH-L1 biomarkers for computed tomography exclusion in mild traumatic brain injury (mTBI)

Jacopo M Legramante #  1   2 , Marilena Minieri #  3   4   5 , Marzia Belli  2 , Alfredo Giovannelli  6 , Alessia Agnoli  6 , Daniela Bajo  6 , Lorenza Bellincampi  6 , Anna Maria De Angelis  6 , Alessandro Terrinoni  7   6 , Massimo Pieri  7   6 , Eleonora Nicolai  7 , Vito N Di Lecce  2 , Carla Paganelli  2 , Gianluigi Ferrazza  1   2 , Susanna Longo  1   2 , Marco Ciotti  6 , Sergio Bernardini  7   6
Affiliations

Evaluation of GFAP/UCH-L1 biomarkers for computed tomography exclusion in mild traumatic brain injury (mTBI)

Jacopo M Legramante et al. Int J Emerg Med. .

Abstract

Introduction: Mild traumatic brain injury (mTBI) represents a major public health concern and affects millions of people worldwide every year. Diagnosis mainly relies on clinical criteria and computed tomography (CT) scans. GFAP (glial fibrillary acidic protein) and UCH-L1 (ubiquitin carboxyl-terminal hydrolase-L1) have been recently studied as potential biomarkers of mTBI. This study retrospectively evaluated the possible use of these combined biomarkers as negative predictors for excluding brain injuries in patients with suspected mTBI in the emergency department.

Methods: Adult patients (n = 130) enrolled at Tor Vergata University Hospital (Rome, Italy), consecutively registered at the triage of the emergency department between October 2022 and January 2023, with non-penetrating TBI and Glasgow Coma Scale (GCS) score of 13-15, were considered. All eligible patients underwent intracranial CT scans and blood tests, within 12 h after trauma, for GFAP and UCH-L1 serum concentrations.

Results: Intracranial CT detected injuries in only seven patients (5%); GFAP and UCH-L1 tested positive in 96 patients and negative in 34 patients (74% vs. 26%). Combined biomarkers had a sensitivity equal to 1.00 (95% CI 0.64-1.00) and a negative predictive value (NPV) of 1.00 (0.99-1.00) in mTBI diagnosis with a negative CT.

Conclusions: Combined laboratory tests for GFAP and UCH-L1 biomarkers might play a potential clinical role in avoiding unnecessary head CT scans after mTBI in emergency departments.

Keywords: Biomarkers; Diagnostic accuracy; Head CT scan; Mild traumatic brain injury; Patient treatment turnaround time.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The pie chart shows the relative proportion (%) of causes of brain injuries in the analyzed population. Retrieved categories are reported in picture legend
Fig. 2
Fig. 2
Age and biomarkers expression. Box-and-whiskers plot of UCH-L1 expressed in pg/mL (A), and GFAP expressed in pg/mL (B) at different age clusters as shown in picture. Box plots indicate the median and interquartile range (IQR); the whiskers represent 1.5 times the IQR. Significant p-values are indicated over the brackets. Histogram represents percentual positive rate in indicated age clusters (C)
Fig. 3
Fig. 3
Time gap analysis. The lower end of histograms represents the minimal time difference (in hours) from patient ED presentation time (0 h). The higher end of the histograms represents the median time. The upper whiskers represent the third quartile of the distribution
See this image and copyright information in PMC

References

    1. Cancelliere C, Verville L, Stubbs JL, Yu H, Hincapié CA, Cassidy JD, et al. Post-concussion symptoms and disability in adults with mild traumatic brain Injury: a systematic review and Meta-analysis. J Neurotrauma. 2023;40(11–12):1045–59. - PubMed
    1. Bosch de Basea Gomez M, Thierry-Chef I, Harbron R, Hauptmann M, Byrnes G, Bernier MO, et al. Risk of hematological malignancies from CT radiation exposure in children, adolescents and young adults. Nat Med. 2023;29(12):3111–9. - PMC - PubMed
    1. Sapin V, Gaulmin R, Aubin R, Walrand S, Coste A, Abbot M. Blood biomarkers of mild traumatic brain injury: state of art. Neurochirurgie. 2021;67(3):249–54. - PubMed
    1. Anderson TN, Hwang J, Munar M, Papa L, Hinson HE, Vaughan A, et al. Blood-based biomarkers for prediction of intracranial hemorrhage and outcome in patients with moderate or severe traumatic brain injury. J Trauma Acute Care Surg. 2020;89(1):80–6. - PMC - PubMed
    1. Stępniewska E, Kałas M, Świderska J, Siemiński M. mTBI biological biomarkers as predictors of Postconcussion Syndrome—Review. Brain Sci. 2024;14(5):513. - PMC - PubMed

LinkOut - more resources