Early Levels of Glial Fibrillary Acidic Protein and Neurofilament Light Protein in Predicting the Outcome of Mild Traumatic Brain Injury

Iftakher Hossain (Corresponding Author), Mehrbod Mohammadian, Riikka S.K. Takala, Olli Tenovuo, Linnéa Lagerstedt, Henna Maria Ala-Seppälä, Janek Frantzén, Mark van Gils, Peter John Hutchinson, Ari J. Katila, Henna-Riikka Maanpää, David Menon, Virginia Newcombe, Jussi Tallus, Kevin Hrusovsky, David Wilson, Kaj Blennow, Jean-Charles Sanchez, Henrik Zetterberg, Jussi P. Posti

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The purpose of this study was to correlate the early levels of glial fibrillary acidic protein (GFAP) and neurofilament light protein (NF-L) with outcome in patients with mild traumatic brain injury (mTBI). A total of 107 patients with mTBI (Glasgow Coma Scale ≥13) who had blood samples for GFAP and NF-L available within 24 h of arrival were included. Patients with mTBI were divided into computed tomography (CT)-positive and CT-negative groups. Glasgow Outcome Scale-Extended (GOSE) was used to assess the outcome. Outcomes were defined as complete (GOSE 8) versus incomplete (GOSE <8), and favorable (GOSE 5-8) versus unfavorable (GOSE 1-4). GFAP and NF-L concentrations in blood were measured using ultrasensitive single molecule array technology. Patients with incomplete recovery had significantly higher levels of NF-L compared with those with complete recovery (p = 0.005). The levels of GFAP and NF-L were significantly higher in patients with unfavorable outcome than in patients with favorable outcome (p = 0.002 for GFAP and p < 0.001 for NF-L). For predicting favorable outcome, the area under the receiver operating characteristic curve for GFAP and NF-L was 0.755 and 0.826, respectively. In a multi-variate logistic regression model, the level of NF-L was still a significant predictor for complete recovery (odds ratio [OR] = 1.008; 95% confidence interval [CI], 1.000-1.016). Moreover, the level of NF-L was a significant predictor for complete recovery in CT-positive patients (OR = 1.009; 95% CI, 1.001-1.016). The early levels of GFAP and NF-L are significantly correlated with the outcome in patients with mTBI. The level of NF-L within 24 h from arrival has a significant predictive value in mTBI also in a multi-variate model.

Original languageEnglish
Pages (from-to)1551-1560
JournalJournal of Neurotrauma
Issue number10
Early online date8 Jan 2019
Publication statusPublished - 15 May 2019
MoE publication typeA1 Journal article-refereed



  • biomarkes
  • traumatic brain injury
  • outcome measures

Cite this

Hossain, I., Mohammadian, M., Takala, R. S. K., Tenovuo, O., Lagerstedt, L., Ala-Seppälä, H. M., Frantzén, J., van Gils, M., Hutchinson, P. J., Katila, A. J., Maanpää, H-R., Menon, D., Newcombe, V., Tallus, J., Hrusovsky, K., Wilson, D., Blennow, K., Sanchez, J-C., Zetterberg, H., & Posti, J. P. (2019). Early Levels of Glial Fibrillary Acidic Protein and Neurofilament Light Protein in Predicting the Outcome of Mild Traumatic Brain Injury. Journal of Neurotrauma, 36(10), 1551-1560. https://doi.org/10.1089/NEU.2018.5952