Glial fibrillary acidic protein and ubiquitin C-terminal hydrolase-L1 as outcome predictors in traumatic brain injury

Riikka S.K. Takala (Corresponding Author), Jussi P. Posti, Hilkka Runtti, Virginia F. Newcombe, Joanne Outtrim, Ari J. Katila, Janek Frantzén, Henna Ala-Seppälä, Anna Kyllönen, Henna-Riikka Maanpää, Jussi Tallus, Md. Iftakher Hossain, Jonathan P. Coles, Peter Hutchinson, Mark van Gils, David K. Menon, Olli Tenovuo

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Abstract

Objective Biomarkers ubiquitin C-terminal hydrolase-L1 (UCH-L1) and glial fibrillary acidic protein (GFAP) may help detect brain injury, assess its severity, and improve outcome prediction. This study aimed to evaluate the prognostic value of these biomarkers during the first days after brain injury. Methods Serum UCH-L1 and GFAP were measured in 324 patients with traumatic brain injury (TBI) enrolled in a prospective study. The outcome was assessed using the Glasgow Outcome Scale (GOS) or the extended version, Glasgow Outcome Scale-Extended (GOSE). Results Patients with full recovery had lower UCH-L1 concentrations on the second day and patients with favorable outcome had lower UCH-L1 concentrations during the first 2 days compared with patients with incomplete recovery and unfavorable outcome. Patients with full recovery and favorable outcome had significantly lower GFAP concentrations in the first 2 days than patients with incomplete recovery or unfavorable outcome. There was a strong negative correlation between outcome and UCH-L1 in the first 3 days and GFAP levels in the first 2 days. On arrival, both UCH-L1 and GFAP distinguished patients with GOS score 1-3 from patients with GOS score 4-5, but not patients with GOSE score 8 from patients with GOSE score 1-7. For UCH-L1 and GFAP to predict unfavorable outcome (GOS score =3), the area under the receiver operating characteristic curve was 0.727, and 0.723, respectively. Neither UCHL-1 nor GFAP was independently able to predict the outcome when age, worst Glasgow Coma Scale score, pupil reactivity, Injury Severity Score, and Marshall score were added into the multivariate logistic regression model. Conclusions GFAP and UCH-L1 are significantly associated with outcome, but they do not add predictive power to commonly used prognostic variables in a population of patients with TBI of varying severities.
Original languageEnglish
Pages (from-to)8-20
JournalWorld Neurosurgery
Volume87
DOIs
Publication statusPublished - 2016
MoE publication typeA1 Journal article-refereed

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Ubiquitin Thiolesterase
Glial Fibrillary Acidic Protein
Protein C
Glasgow Outcome Scale
Brain Injuries
Traumatic Brain Injury
Biomarkers
Logistic Models
Glasgow Coma Scale
Injury Severity Score
Pupil
ROC Curve

Keywords

  • biomarkers
  • GFAP
  • outcome
  • traumatic brain injury
  • UCH-L1

Cite this

Takala, R. S. K., Posti, J. P., Runtti, H., Newcombe, V. F., Outtrim, J., Katila, A. J., ... Tenovuo, O. (2016). Glial fibrillary acidic protein and ubiquitin C-terminal hydrolase-L1 as outcome predictors in traumatic brain injury. World Neurosurgery, 87, 8-20. https://doi.org/10.1016/j.wneu.2015.10.066
Takala, Riikka S.K. ; Posti, Jussi P. ; Runtti, Hilkka ; Newcombe, Virginia F. ; Outtrim, Joanne ; Katila, Ari J. ; Frantzén, Janek ; Ala-Seppälä, Henna ; Kyllönen, Anna ; Maanpää, Henna-Riikka ; Tallus, Jussi ; Hossain, Md. Iftakher ; Coles, Jonathan P. ; Hutchinson, Peter ; van Gils, Mark ; Menon, David K. ; Tenovuo, Olli. / Glial fibrillary acidic protein and ubiquitin C-terminal hydrolase-L1 as outcome predictors in traumatic brain injury. In: World Neurosurgery. 2016 ; Vol. 87. pp. 8-20.
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title = "Glial fibrillary acidic protein and ubiquitin C-terminal hydrolase-L1 as outcome predictors in traumatic brain injury",
abstract = "Objective Biomarkers ubiquitin C-terminal hydrolase-L1 (UCH-L1) and glial fibrillary acidic protein (GFAP) may help detect brain injury, assess its severity, and improve outcome prediction. This study aimed to evaluate the prognostic value of these biomarkers during the first days after brain injury. Methods Serum UCH-L1 and GFAP were measured in 324 patients with traumatic brain injury (TBI) enrolled in a prospective study. The outcome was assessed using the Glasgow Outcome Scale (GOS) or the extended version, Glasgow Outcome Scale-Extended (GOSE). Results Patients with full recovery had lower UCH-L1 concentrations on the second day and patients with favorable outcome had lower UCH-L1 concentrations during the first 2 days compared with patients with incomplete recovery and unfavorable outcome. Patients with full recovery and favorable outcome had significantly lower GFAP concentrations in the first 2 days than patients with incomplete recovery or unfavorable outcome. There was a strong negative correlation between outcome and UCH-L1 in the first 3 days and GFAP levels in the first 2 days. On arrival, both UCH-L1 and GFAP distinguished patients with GOS score 1-3 from patients with GOS score 4-5, but not patients with GOSE score 8 from patients with GOSE score 1-7. For UCH-L1 and GFAP to predict unfavorable outcome (GOS score =3), the area under the receiver operating characteristic curve was 0.727, and 0.723, respectively. Neither UCHL-1 nor GFAP was independently able to predict the outcome when age, worst Glasgow Coma Scale score, pupil reactivity, Injury Severity Score, and Marshall score were added into the multivariate logistic regression model. Conclusions GFAP and UCH-L1 are significantly associated with outcome, but they do not add predictive power to commonly used prognostic variables in a population of patients with TBI of varying severities.",
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Takala, RSK, Posti, JP, Runtti, H, Newcombe, VF, Outtrim, J, Katila, AJ, Frantzén, J, Ala-Seppälä, H, Kyllönen, A, Maanpää, H-R, Tallus, J, Hossain, MI, Coles, JP, Hutchinson, P, van Gils, M, Menon, DK & Tenovuo, O 2016, 'Glial fibrillary acidic protein and ubiquitin C-terminal hydrolase-L1 as outcome predictors in traumatic brain injury', World Neurosurgery, vol. 87, pp. 8-20. https://doi.org/10.1016/j.wneu.2015.10.066

Glial fibrillary acidic protein and ubiquitin C-terminal hydrolase-L1 as outcome predictors in traumatic brain injury. / Takala, Riikka S.K. (Corresponding Author); Posti, Jussi P.; Runtti, Hilkka; Newcombe, Virginia F.; Outtrim, Joanne; Katila, Ari J.; Frantzén, Janek; Ala-Seppälä, Henna; Kyllönen, Anna; Maanpää, Henna-Riikka; Tallus, Jussi; Hossain, Md. Iftakher; Coles, Jonathan P.; Hutchinson, Peter; van Gils, Mark; Menon, David K.; Tenovuo, Olli.

In: World Neurosurgery, Vol. 87, 2016, p. 8-20.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Glial fibrillary acidic protein and ubiquitin C-terminal hydrolase-L1 as outcome predictors in traumatic brain injury

AU - Takala, Riikka S.K.

AU - Posti, Jussi P.

AU - Runtti, Hilkka

AU - Newcombe, Virginia F.

AU - Outtrim, Joanne

AU - Katila, Ari J.

AU - Frantzén, Janek

AU - Ala-Seppälä, Henna

AU - Kyllönen, Anna

AU - Maanpää, Henna-Riikka

AU - Tallus, Jussi

AU - Hossain, Md. Iftakher

AU - Coles, Jonathan P.

AU - Hutchinson, Peter

AU - van Gils, Mark

AU - Menon, David K.

AU - Tenovuo, Olli

N1 - SDA: MIP: Personalized H&WB

PY - 2016

Y1 - 2016

N2 - Objective Biomarkers ubiquitin C-terminal hydrolase-L1 (UCH-L1) and glial fibrillary acidic protein (GFAP) may help detect brain injury, assess its severity, and improve outcome prediction. This study aimed to evaluate the prognostic value of these biomarkers during the first days after brain injury. Methods Serum UCH-L1 and GFAP were measured in 324 patients with traumatic brain injury (TBI) enrolled in a prospective study. The outcome was assessed using the Glasgow Outcome Scale (GOS) or the extended version, Glasgow Outcome Scale-Extended (GOSE). Results Patients with full recovery had lower UCH-L1 concentrations on the second day and patients with favorable outcome had lower UCH-L1 concentrations during the first 2 days compared with patients with incomplete recovery and unfavorable outcome. Patients with full recovery and favorable outcome had significantly lower GFAP concentrations in the first 2 days than patients with incomplete recovery or unfavorable outcome. There was a strong negative correlation between outcome and UCH-L1 in the first 3 days and GFAP levels in the first 2 days. On arrival, both UCH-L1 and GFAP distinguished patients with GOS score 1-3 from patients with GOS score 4-5, but not patients with GOSE score 8 from patients with GOSE score 1-7. For UCH-L1 and GFAP to predict unfavorable outcome (GOS score =3), the area under the receiver operating characteristic curve was 0.727, and 0.723, respectively. Neither UCHL-1 nor GFAP was independently able to predict the outcome when age, worst Glasgow Coma Scale score, pupil reactivity, Injury Severity Score, and Marshall score were added into the multivariate logistic regression model. Conclusions GFAP and UCH-L1 are significantly associated with outcome, but they do not add predictive power to commonly used prognostic variables in a population of patients with TBI of varying severities.

AB - Objective Biomarkers ubiquitin C-terminal hydrolase-L1 (UCH-L1) and glial fibrillary acidic protein (GFAP) may help detect brain injury, assess its severity, and improve outcome prediction. This study aimed to evaluate the prognostic value of these biomarkers during the first days after brain injury. Methods Serum UCH-L1 and GFAP were measured in 324 patients with traumatic brain injury (TBI) enrolled in a prospective study. The outcome was assessed using the Glasgow Outcome Scale (GOS) or the extended version, Glasgow Outcome Scale-Extended (GOSE). Results Patients with full recovery had lower UCH-L1 concentrations on the second day and patients with favorable outcome had lower UCH-L1 concentrations during the first 2 days compared with patients with incomplete recovery and unfavorable outcome. Patients with full recovery and favorable outcome had significantly lower GFAP concentrations in the first 2 days than patients with incomplete recovery or unfavorable outcome. There was a strong negative correlation between outcome and UCH-L1 in the first 3 days and GFAP levels in the first 2 days. On arrival, both UCH-L1 and GFAP distinguished patients with GOS score 1-3 from patients with GOS score 4-5, but not patients with GOSE score 8 from patients with GOSE score 1-7. For UCH-L1 and GFAP to predict unfavorable outcome (GOS score =3), the area under the receiver operating characteristic curve was 0.727, and 0.723, respectively. Neither UCHL-1 nor GFAP was independently able to predict the outcome when age, worst Glasgow Coma Scale score, pupil reactivity, Injury Severity Score, and Marshall score were added into the multivariate logistic regression model. Conclusions GFAP and UCH-L1 are significantly associated with outcome, but they do not add predictive power to commonly used prognostic variables in a population of patients with TBI of varying severities.

KW - biomarkers

KW - GFAP

KW - outcome

KW - traumatic brain injury

KW - UCH-L1

U2 - 10.1016/j.wneu.2015.10.066

DO - 10.1016/j.wneu.2015.10.066

M3 - Article

VL - 87

SP - 8

EP - 20

JO - World Neurosurgery

JF - World Neurosurgery

SN - 1878-8750

ER -