Glial fibrillary acidic protein in serum after traumatic brain injury and multiple trauma.
BACKGROUND
This study aimed to determine whether glial fibrillary acidic protein (GFAP) is released after traumatic brain injury (TBI), whether GFAP is related to brain injury severity and outcome after TBI, and whether GFAP is released after multiple trauma without TBI.


METHODS
This prospective study enrolled 114 patients who had TBI with or without multiple trauma (n = 101) or multiple trauma without TBI (n = 13), as verified by computerized tomography. Daily GFAP measurement began at admission (<12 hours after trauma) and continued for the duration of intensive care (1-22 days). Documentation included categorization of computerized tomography according to Marshall classification, based on daily highest intracranial pressure (ICP), lowest cerebral perfusion pressure (CPP), lowest mean arterial pressure (MAP), and 3-month Glasgow Outcome Score (GOS).


RESULTS
The GFAP concentration was lower for diffuse injury 2 than for diffuse injury 4 (p < 0.0005) or nonevacuated mass lesions larger than than 25 mL (p < 0.005), lower for a ICP less than 25 mm Hg than for a ICP of 25 mm Hg or more, lower for a CPP of 60 mm Hg or more than for a CPP of 60 mm Hg or less, lower for a MAP of 60 mm Hg or more than for a MAP less than 60 mm Hg (all p < 0.0005), and lower for a GOS of 1 or 2 than for a GOS of 3, 4 (p < 0.05), or 5 (p < 0.0005). After TBI, GFAP was higher in nonsurvivors (n = 39) than in survivors (n = 62) (p < 0.005). After multiple trauma without TBI, GFAP remained normal.


CONCLUSIONS
The findings showed that GFAP is released after TBI, that GFAP is related to brain injury severity and outcome after TBI, and that GFAP is not released after multiple trauma without brain injury.
Pelinka
Linda E
LE
Ludwig Boltzmann Institute for Experimental and Clinical Traumatology and Research Unit of the Austrian Worker's Compensation Board, Vienna, Austria. lindapel@via.at
Kroepfl
Alfred
A
Schmidhammer
R
R
Krenn
Manfred
M
Buchinger
Walter
W
Redl
Heinz
H
Raabe
Andreas
A
D000328:Adult; D001317:Austria / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D001930:Brain Injuries / Q000097:blood* / Q000000981:diagnostic imaging / Q000401:mortality*; D015600:Glasgow Coma Scale; D023261:Glasgow Outcome Scale; D005904:Glial Fibrillary Acidic Protein / Q000097:blood*; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology; D009104:Multiple Trauma / Q000097:blood* / Q000000981:diagnostic imaging / Q000401:mortality*; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D016896:Treatment Outcome
D015415:Biomarkers; D005904:Glial Fibrillary Acidic Protein