Discover the cutting-edge biomarkers revolutionizing early detection of intracranial injuries: S100B, GFAP, and UCH-L1’s performance within the critical first 6 hours post-trauma and their implications for neurotrauma surgery.
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Screening Performance of S100B, GFAP and UCH-L1 For Intracranial Injury Within 6 hours of Injury and beyond .
Trivedi et al., J Neurotrauma 2023
DOI: 10.1089/neu.2023.0322
Study Summary:
The study assessed the effectiveness of the biomarkers S100B, GFAP, and UCH-L1 in detecting traumatic brain injury (TBI) within and beyond a 6-hour window post-injury in patients with a Glasgow coma scale (GCS) of 14-15. The analysis used data from the CENTER-TBI core database, focusing on patients who had blood samples taken within 6, 6-9, and 9-12 hours after injury.
Key Findings:
- Diagnostic Performance: GFAP and UCH-L1 had higher area under the receiver operating characteristic curve (AUC) values than S100B within the 6-hour window, indicating better diagnostic performance for intracranial injuries. Specifically, GFAP’s AUC was 0.86 (95% CI: 0.82-0.90) and UCH-L1’s was 0.81 (95% CI: 0.76-0.85), compared to S100B’s 0.74 (95% CI: 0.69-0.79).
- Timeframe Analysis: S100B’s predictive ability did not significantly change when tested at different time intervals post-injury (6, 6-9, and 9-12 hours).
- Combined Biomarkers: There was no significant benefit in combining GFAP and UCH-L1 over using GFAP alone for screening within the studied timeframes.
Implications:
The findings suggest that GFAP and UCH-L1 are more accurate than S100B for early detection of TBI within the first 6 hours after injury. The consistent performance of S100B beyond the 6-hour mark also indicates its potential utility outside the current Scandinavian NeuroTrauma Committee (SNC) guidelines’ recommended window. This study prompts a reconsideration of the SNC guidelines for TBI biomarker testing.