Increased serum-GFAP in patients with severe traumatic brain injury is related to outcome.
OBJECTIVE
Several studies have established the relevance of S-100 in blood as a marker of brain damage after traumatic brain injury. However, a more specific marker is required and glial fibrillary acidic protein (GFAP) is considered to be a good candidate.


METHODS
In order to assess the increase of GFAP in serum (s-GFAP) after a severe traumatic brain injury (TBI) we collected daily serum samples from 59 patients with severe TBI starting on the day of the trauma. S-GFAP was measured using a sandwich ELISA. The Glasgow outcome scale (GOS) assessed outcome after 1 year.


RESULTS
All but one patient had maximal s-GFAP values above the laboratory reference value (median increased 10-fold). The highest detected levels were seen during the first days after TBI and then decreased gradually. Patients with unfavourable outcome had significantly (p<0.001) higher maximal s-GFAP values in the acute phase compared with patients with favourable outcome. All patients (n=5) with s-GFAP>15.04 microg /L died (reference level<0.15 microg/L). We found no significant difference in the maximal s-GFAP levels of patients with isolated brain injury in comparison with patients with multiple traumas.


CONCLUSIONS
Serum-GFAP is increased during the first days after a severe traumatic brain injury and related to clinical outcome.
Nylén
K
K
Department of Neurology, Institute of Clinical Neuroscience, Sahlgrenska University Hospital, University of Göteborg, S-413 45 Göteborg, Sweden. karin.nylen@neuro.gu.se
Ost
M
M
Csajbok
L Z
LZ
Nilsson
I
I
Blennow
K
K
Nellgård
B
B
Rosengren
L
L
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000097:blood*; D002648:Child; D004797:Enzyme-Linked Immunosorbent Assay / Q000379:methods; D005069:Evaluation Studies as Topic; D005260:Female; D015600:Glasgow Coma Scale; D023261:Glasgow Outcome Scale; D005904:Glial Fibrillary Acidic Protein / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012016:Reference Values; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors
D005904:Glial Fibrillary Acidic Protein