title: Brain injury biomarkers may improve the predictive power of the IMPACT outcome calculator.
abstract: Outcome prediction following severe traumatic brain injury (sTBI) is a widely investigated field of research. A major breakthrough is represented by the IMPACT prognostic calculator based on admission data of more than 8500 patients. A growing body of scientific evidence has shown that clinically meaningful biomarkers, including glial fibrillary acidic protein (GFAP), ubiquitin C-terminal hydrolase-L1 (UCH-L1), and αII-spectrin breakdown product (SBDP145), could also contribute to outcome prediction. The present study was initiated to assess whether the addition of biomarkers to the IMPACT prognostic calculator could improve its predictive power. Forty-five sTBI patients (GCS score≤8) from four different sites were investigated. We utilized the core model of the IMPACT calculator (age, GCS motor score, and reaction of pupils), and measured the level of GFAP, UCH-L1, and SBDP145 in serum and cerebrospinal fluid (CSF). The forecast and actual 6-month outcomes were compared by logistic regression analysis. The results of the core model itself, as well as serum values of GFAP and CSF levels of SBDP145, showed a significant correlation with the 6-month mortality using a univariate analysis. In the core model, the Nagelkerke R(2) value was 0.214. With multivariate analysis we were able to increase this predictive power with one additional biomarker (GFAP in CSF) to R(2)=0.476, while the application of three biomarker levels (GFAP in CSF, GFAP in serum, and SBDP145 in CSF) increased the Nagelkerke R(2) to 0.700. Our preliminary results underline the importance of biomarkers in outcome prediction, and encourage further investigation to expand the predictive power of contemporary outcome calculators and prognostic models in TBI.
authors.affiliation: Department of Neurosurgery, Medical School, University of Pecs, Pecs, Hungary. endre.czeiter@gmail.com
authors.forename: Endre
authors.initials: E
authors.lastname: Czeiter
authors.forename: Stefania
authors.initials: S
authors.lastname: Mondello
authors.forename: Noemi
authors.initials: N
authors.lastname: Kovacs
authors.forename: Janos
authors.initials: J
authors.lastname: Sandor
authors.forename: Andrea
authors.initials: A
authors.lastname: Gabrielli
authors.forename: Kara
authors.initials: K
authors.lastname: Schmid
authors.forename: Frank
authors.initials: F
authors.lastname: Tortella
authors.forename: Kevin K W
authors.initials: KK
authors.lastname: Wang
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Hayes
authors.forename: Pal
authors.initials: P
authors.lastname: Barzo
authors.forename: Erzsebet
authors.initials: E
authors.lastname: Ezer
authors.forename: Tamas
authors.initials: T
authors.lastname: Doczi
authors.forename: Andras
authors.initials: A
authors.lastname: Buki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015415:Biomarkers / Q000032:analysis*; D001930:Brain Injuries / Q000378:metabolism* / Q000401:mortality; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D015600:Glasgow Coma Scale; D005904:Glial Fibrillary Acidic Protein / Q000097:blood; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008959:Models, Neurological; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D025521:Tumor Suppressor Proteins / Q000097:blood; D043222:Ubiquitin Thiolesterase / Q000097:blood; D055815:Young Adult
chemical_list: C400134:BAP1 protein, human; D015415:Biomarkers; D005904:Glial Fibrillary Acidic Protein; D025521:Tumor Suppressor Proteins; D043222:Ubiquitin Thiolesterase