Combining H-FABP and GFAP increases the capacity to differentiate between CT-positive and CT-negative patients with mild traumatic brain injury.

Lagerstedt L; Egea-Guerrero JJ; Bustamante A; Rodríguez-Rodríguez A; El Rahal A; Quintana-Diaz M; García-Armengol R; Prica CM; Andereggen E; Rinaldi L; Sarrafzadeh A; Schaller K; Montaner J; Sanchez JC

doi:10.1371/journal.pone.0200394

Back

Journal article

Combining H-FABP and GFAP increases the capacity to differentiate between CT-positive and CT-negative patients with mild traumatic brain injury.

Lagerstedt L Department of Specialities of Internal Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Egea-Guerrero JJ NeuroCritical Care Unit, Virgen del Rocío University Hospital, Seville, Spain.
Bustamante A Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.
Rodríguez-Rodríguez A NeuroCritical Care Unit, Virgen del Rocío University Hospital, Seville, Spain.
El Rahal A Division of Neurosurgery, Geneva Neuroscience Center, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland.
Quintana-Diaz M Intensive Medicine Unit, Hospital Universitario La Paz, idiPAZ, Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
García-Armengol R Neurosurgical Department, Neuroscience Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
Prica CM Emergency Department, Hospital de Tortosa Verge de la Cinta, Tortosa, Spain.
Andereggen E Emergency Center, Geneva University Hospitals, Geneva, Switzerland.
Rinaldi L Emergency Center, Geneva University Hospitals, Geneva, Switzerland.
Sarrafzadeh A Division of Neurosurgery, Geneva Neuroscience Center, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland.
Schaller K Division of Neurosurgery, Geneva Neuroscience Center, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland.
Montaner J Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.
Sanchez JC Department of Specialities of Internal Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland.

2018-07-10

Published in:

PloS one. - 2018

Glial Fibrillary Acidic Protein

S100 Calcium Binding Protein beta Subunit

English Mild traumatic brain injury (mTBI) patients may have trauma-induced brain lesions detectable using CT scans. However, most patients will be CT-negative. There is thus a need for an additional tool to detect patients at risk. Single blood biomarkers, such as S100B and GFAP, have been widely studied in mTBI patients, but to date, none seems to perform well enough. In many different diseases, combining several biomarkers into panels has become increasingly interesting for diagnoses and to enhance classification performance. The present study evaluated 13 proteins individually-H-FABP, MMP-1, MMP-3, MMP-9, VCAM, ICAM, SAA, CRP, GSTP, NKDA, PRDX1, DJ-1 and IL-10-for their capacity to differentiate between patients with and without a brain lesion according to CT results. The best performing proteins were then compared and combined with the S100B and GFAP proteins into a CT-scan triage panel. Patients diagnosed with mTBI, with a Glasgow Coma Scale score of 15 and one additional clinical symptom were enrolled at three different European sites. A blood sample was collected at hospital admission, and a CT scan was performed. Patients were divided into two two-centre cohorts and further dichotomised into CT-positive and CT-negative groups for statistical analysis. Single markers and panels were evaluated using Cohort 1. Four proteins-H-FABP, IL-10, S100B and GFAP-showed significantly higher levels in CT-positive patients. The best-performing biomarker was H-FABP, with a specificity of 32% (95% CI 23-40) and sensitivity reaching 100%. The best-performing two-marker panel for Cohort 1, subsequently validated in Cohort 2, was a combination of H-FABP and GFAP, enhancing specificity to 46% (95% CI 36-55). When adding IL-10 to this panel, specificity reached 52% (95% CI 43-61) with 100% sensitivity. These results showed that proteins combined into panels could be used to efficiently classify CT-positive and CT-negative mTBI patients.

Language