title: Ubiquitin C-terminal hydrolase is a novel biomarker in humans for severe traumatic brain injury.
abstract: 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.
authors.affiliation: Department of Emergency Medicine, Orlando Regional Medical Center, Orlando, FL, USA. lpstat@aol.com
authors.forename: Linda
authors.initials: L
authors.lastname: Papa
authors.forename: Linnet
authors.initials: L
authors.lastname: Akinyi
authors.forename: Ming Cheng
authors.initials: MC
authors.lastname: Liu
authors.forename: Jose A
authors.initials: JA
authors.lastname: Pineda
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Tepas
authors.forename: Monika W
authors.initials: MW
authors.lastname: Oli
authors.forename: Wenrong
authors.initials: W
authors.lastname: Zheng
authors.forename: Gillian
authors.initials: G
authors.lastname: Robinson
authors.forename: Steven A
authors.initials: SA
authors.lastname: Robicsek
authors.forename: Andrea
authors.initials: A
authors.lastname: Gabrielli
authors.forename: Shelley C
authors.initials: SC
authors.lastname: Heaton
authors.forename: H Julia
authors.initials: HJ
authors.lastname: Hannay
authors.forename: Jason A
authors.initials: JA
authors.lastname: Demery
authors.forename: Gretchen M
authors.initials: GM
authors.lastname: Brophy
authors.forename: Joe
authors.initials: J
authors.lastname: Layon
authors.forename: Claudia S
authors.initials: CS
authors.lastname: Robertson
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Hayes
authors.forename: Kevin K W
authors.initials: KK
authors.lastname: Wang
mesh_terms: 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
chemical_list: D015415:Biomarkers; D043222:Ubiquitin Thiolesterase