Ubiquitin C-terminal hydrolase is a novel biomarker in humans for severe traumatic brain injury.
OBJECTIVE
Ubiquitin C-terminal hydrolase (UCH-L1), also called neuronal-specific protein gene product (PGP 9.3), is highly abundant in neurons. To assess the reliability of UCH-L1 as a potential biomarker for traumatic brain injury (TBI) this study compared cerebrospinal fluid (CSF) levels of UCH-L1 from adult patients with severe TBI to uninjured controls; and examined the relationship between levels with severity of injury, complications and functional outcome.


METHODS
This study was designed as prospective case control study.


METHODS
This study enrolled 66 patients, 41 with severe TBI, defined by a Glasgow coma scale (GCS) score of < or =8, who underwent intraventricular intracranial pressure monitoring and 25 controls without TBI requiring CSF drainage for other medical reasons.


METHODS
: Two hospital system level I trauma centers.


RESULTS
Ventricular CSF was sampled from each patient at 6, 12, 24, 48, 72, 96, 120, 144, and 168 hrs following TBI and analyzed for UCH-L1. Injury severity was assessed by the GCS score, Marshall Classification on computed tomography and a complicated postinjury course. Mortality was assessed at 6 wks and long-term outcome was assessed using the Glasgow outcome score 6 months after injury. TBI patients had significantly elevated CSF levels of UCH-L1 at each time point after injury compared to uninjured controls. Overall mean levels of UCH-L1 in TBI patients was 44.2 ng/mL (+/-7.9) compared with 2.7 ng/mL (+/-0.7) in controls (p <.001). There were significantly higher levels of UCH-L1 in patients with a lower GCS score at 24 hrs, in those with postinjury complications, in those with 6-wk mortality, and in those with a poor 6-month dichotomized Glasgow outcome score.


CONCLUSIONS
These data suggest that this novel biomarker has the potential to determine injury severity in TBI patients. Further studies are needed to validate these findings in a larger sample.
Papa
Linda
L
Department of Emergency Medicine, Orlando Regional Medical Center, Orlando, FL, USA. lpstat@aol.com
Akinyi
Linnet
L
Liu
Ming Cheng
MC
Pineda
Jose A
JA
Tepas
Joseph J
JJ
Oli
Monika W
MW
Zheng
Wenrong
W
Robinson
Gillian
G
Robicsek
Steven A
SA
Gabrielli
Andrea
A
Heaton
Shelley C
SC
Hannay
H Julia
HJ
Demery
Jason A
JA
Brophy
Gretchen M
GM
Layon
Joe
J
Robertson
Claudia S
CS
Hayes
Ronald L
RL
Wang
Kevin K W
KK
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000134:cerebrospinal fluid; D001930:Brain Injuries / Q000134:cerebrospinal fluid* / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D016022:Case-Control Studies; D002423:Cause of Death; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D012016:Reference Values; D018570:Risk Assessment; D012737:Sex Factors; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D014193:Trauma Centers; D043222:Ubiquitin Thiolesterase / Q000134:cerebrospinal fluid* / Q000378:metabolism; D055815:Young Adult
D015415:Biomarkers; D043222:Ubiquitin Thiolesterase