title: Blood biomarkers for brain injury in concussed professional ice hockey players.
abstract: OBJECTIVE
  Lack of objective biomarkers for brain damage hampers acute diagnosis and clinical decision making about return to play after sports-related concussion.
  
  
  OBJECTIVE
  To determine whether sports-related concussion is associated with elevated levels of blood biochemical markers of injury to the central nervous system and to assess whether plasma levels of these biomarkers predict return to play in professional ice hockey players with sports-related concussion.
  
  
  METHODS
  Multicenter prospective cohort study involving all 12 teams of the top professional ice hockey league in Sweden, the Swedish Hockey League. Two hundred eighty-eight professional ice hockey players from 12 teams contesting during the 2012-2013 season consented to participate. All players underwent clinical preseason baseline testing regarding concussion assessment measures. Forty-seven players from 2 of the 12 ice hockey teams underwent blood sampling prior to the start of the season. Thirty-five players had a concussion from September 13, 2012, to January 31, 2013; of these players, 28 underwent repeated blood sampling at 1, 12, 36, and 144 hours and when the players returned to play.
  
  
  METHODS
  Total tau, S-100 calcium-binding protein B, and neuron-specific enolase concentrations in plasma and serum were measured.
  
  
  RESULTS
  Concussed players had increased levels of the axonal injury biomarker total tau(median, 10.0 pg/mL; range, 2.0-102 pg/mL) compared with preseason values (median, 4.5pg/mL; range, 0.06-22.7 pg/mL) (P < .001). The levels of the astroglial injury biomarker S-100 calcium-binding protein B were also increased in players with sports-related concussion(median, 0.075 μg/L; range, 0.037-0.24 μg/L) compared with preseason values (median,0.045 μg/L; range, 0.005-0.45 μg/L) (P < .001). The highest biomarker concentrations of total tau and S-100 calcium-binding protein B were measured immediately after a concussion, and they decreased during rehabilitation. No significant changes were detected in the levels of neuron-specific enolase from preseason values (median, 6.5 μg/L; range,3.45-18.0 μg/L) to postconcussion values (median, 6.1 μg/L; range, 3.6-12.8 μg/L) (P = .10).
  
  
  CONCLUSIONS
  Sports-related concussion in professional ice hockey players is associated with acute axonal and astroglial injury. This can be monitored using blood biomarkers, which may be developed into clinical tools to guide sport physicians in the medical counseling of athletes in return-to-play decisions.
authors.forename: Pashtun
authors.initials: P
authors.lastname: Shahim
authors.forename: Yelverton
authors.initials: Y
authors.lastname: Tegner
authors.forename: David H
authors.initials: DH
authors.lastname: Wilson
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Randall
authors.forename: Tobias
authors.initials: T
authors.lastname: Skillbäck
authors.forename: David
authors.initials: D
authors.lastname: Pazooki
authors.forename: Birgitta
authors.initials: B
authors.lastname: Kallberg
authors.forename: Kaj
authors.initials: K
authors.lastname: Blennow
authors.forename: Henrik
authors.initials: H
authors.lastname: Zetterberg
mesh_terms: D000328:Adult; D056352:Athletes; D015415:Biomarkers / Q000097:blood; D001924:Brain Concussion / Q000175:diagnosis*; D015331:Cohort Studies; D003657:Decision Making; D006688:Hockey / Q000293:injuries* / Q000502:physiology; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D011446:Prospective Studies; D013548:Sweden; D055815:Young Adult
chemical_list: D015415:Biomarkers