Serum biomarkers identify critically ill traumatic brain injury patients for MRI
Abstract Background Magnetic resonance imaging (MRI) carries prognostic importance after traumatic brain injury (TBI), especially when computed tomography (CT) fails to fully explain the level of unconsciousness. However, in critically ill patients, the risk of deterioration during transfer needs to...
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| Format: | Article |
| Language: | English |
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BMC
2022-11-01
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| Series: | Critical Care |
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| Online Access: | https://doi.org/10.1186/s13054-022-04250-3 |
| _version_ | 1797985426176212992 |
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| author | Sophie Richter Stefan Winzeck Endre Czeiter Krisztina Amrein Evgenios N. Kornaropoulos Jan Verheyden Gabriela Sugar Zhihui Yang Kevin Wang Andrew I. R. Maas Ewout Steyerberg András Büki Virginia F. J. Newcombe David K. Menon the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury Magnetic Resonance Imaging (CENTER-TBI MRI) Sub-study Participants and Investigators |
| author_facet | Sophie Richter Stefan Winzeck Endre Czeiter Krisztina Amrein Evgenios N. Kornaropoulos Jan Verheyden Gabriela Sugar Zhihui Yang Kevin Wang Andrew I. R. Maas Ewout Steyerberg András Büki Virginia F. J. Newcombe David K. Menon the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury Magnetic Resonance Imaging (CENTER-TBI MRI) Sub-study Participants and Investigators |
| author_sort | Sophie Richter |
| collection | DOAJ |
| description | Abstract Background Magnetic resonance imaging (MRI) carries prognostic importance after traumatic brain injury (TBI), especially when computed tomography (CT) fails to fully explain the level of unconsciousness. However, in critically ill patients, the risk of deterioration during transfer needs to be balanced against the benefit of detecting prognostically relevant information on MRI. We therefore aimed to assess if day of injury serum protein biomarkers could identify critically ill TBI patients in whom the risks of transfer are compensated by the likelihood of detecting management-altering neuroimaging findings. Methods Data were obtained from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. Eligibility criteria included: TBI patients aged ≥ 16 years, Glasgow Coma Score (GCS) < 13 or patient intubated with unrecorded pre-intubation GCS, CT with Marshall score < 3, serum biomarkers (GFAP, NFL, NSE, S100B, Tau, UCH-L1) sampled ≤ 24 h of injury, MRI < 30 days of injury. The degree of axonal injury on MRI was graded using the Adams-Gentry classification. The association between serum concentrations of biomarkers and Adams-Gentry stage was assessed and the optimum threshold concentration identified, assuming different minimum sensitivities for the detection of brainstem injury (Adams-Gentry stage 3). A cost–benefit analysis for the USA and UK health care settings was also performed. Results Among 65 included patients (30 moderate-severe, 35 unrecorded) axonal injury was detected in 54 (83%) and brainstem involvement in 33 (51%). In patients with moderate-severe TBI, brainstem injury was associated with higher concentrations of NSE, Tau, UCH-L1 and GFAP. If the clinician did not want to miss any brainstem injury, NSE could have avoided MRI transfers in up to 20% of patients. If a 94% sensitivity was accepted considering potential transfer-related complications, GFAP could have avoided 30% of transfers. There was no added net cost, with savings up to £99 (UK) or $612 (US). No associations between proteins and axonal injury were found in intubated patients without a recorded pre-intubation GCS. Conclusions Serum protein biomarkers show potential to safely reduce the number of transfers to MRI in critically ill patients with moderate-severe TBI at no added cost. |
| first_indexed | 2024-04-11T07:17:54Z |
| format | Article |
| id | doaj.art-8cd1891a67a84de7a73363066f4d7ef3 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-04-11T07:17:54Z |
| publishDate | 2022-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-8cd1891a67a84de7a73363066f4d7ef32022-12-22T04:37:52ZengBMCCritical Care1364-85352022-11-012611710.1186/s13054-022-04250-3Serum biomarkers identify critically ill traumatic brain injury patients for MRISophie Richter0Stefan Winzeck1Endre Czeiter2Krisztina Amrein3Evgenios N. Kornaropoulos4Jan Verheyden5Gabriela Sugar6Zhihui Yang7Kevin Wang8Andrew I. R. Maas9Ewout Steyerberg10András Büki11Virginia F. J. Newcombe12David K. Menon13the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury Magnetic Resonance Imaging (CENTER-TBI MRI) Sub-study Participants and InvestigatorsUniversity Division of Anaesthesia, University of CambridgeUniversity Division of Anaesthesia, University of CambridgeDepartment of Neurosurgery, Medical School, University of PécsDepartment of Neurosurgery, Medical School, University of PécsDiagnostic Radiology, Department of Clinical Sciences, Lund UniversityResearch and Development, icometrixBrain and Spinal Injury Center, University of California, San FranciscoProgram for Neurotrauma, Neuroproteomics and Biomarker Research, Departments of Emergency Medicine, Psychiatry and Neuroscience, University of FloridaProgram for Neurotrauma, Neuroproteomics and Biomarker Research, Departments of Emergency Medicine, Psychiatry and Neuroscience, University of FloridaDepartment of Neurosurgery, Antwerp University Hospital and University of AntwerpDepartment of Biomedical Data Sciences, University Medical CentreDepartment of Neurosurgery, Medical School, University of PécsUniversity Division of Anaesthesia, University of CambridgeUniversity Division of Anaesthesia, University of CambridgeAbstract Background Magnetic resonance imaging (MRI) carries prognostic importance after traumatic brain injury (TBI), especially when computed tomography (CT) fails to fully explain the level of unconsciousness. However, in critically ill patients, the risk of deterioration during transfer needs to be balanced against the benefit of detecting prognostically relevant information on MRI. We therefore aimed to assess if day of injury serum protein biomarkers could identify critically ill TBI patients in whom the risks of transfer are compensated by the likelihood of detecting management-altering neuroimaging findings. Methods Data were obtained from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. Eligibility criteria included: TBI patients aged ≥ 16 years, Glasgow Coma Score (GCS) < 13 or patient intubated with unrecorded pre-intubation GCS, CT with Marshall score < 3, serum biomarkers (GFAP, NFL, NSE, S100B, Tau, UCH-L1) sampled ≤ 24 h of injury, MRI < 30 days of injury. The degree of axonal injury on MRI was graded using the Adams-Gentry classification. The association between serum concentrations of biomarkers and Adams-Gentry stage was assessed and the optimum threshold concentration identified, assuming different minimum sensitivities for the detection of brainstem injury (Adams-Gentry stage 3). A cost–benefit analysis for the USA and UK health care settings was also performed. Results Among 65 included patients (30 moderate-severe, 35 unrecorded) axonal injury was detected in 54 (83%) and brainstem involvement in 33 (51%). In patients with moderate-severe TBI, brainstem injury was associated with higher concentrations of NSE, Tau, UCH-L1 and GFAP. If the clinician did not want to miss any brainstem injury, NSE could have avoided MRI transfers in up to 20% of patients. If a 94% sensitivity was accepted considering potential transfer-related complications, GFAP could have avoided 30% of transfers. There was no added net cost, with savings up to £99 (UK) or $612 (US). No associations between proteins and axonal injury were found in intubated patients without a recorded pre-intubation GCS. Conclusions Serum protein biomarkers show potential to safely reduce the number of transfers to MRI in critically ill patients with moderate-severe TBI at no added cost.https://doi.org/10.1186/s13054-022-04250-3Traumatic brain injuryTraumatic axonal injuryDiffuse axonal injuryMagnetic resonance imagingGlasgow Coma ScaleSerum protein biomarkers |
| spellingShingle | Sophie Richter Stefan Winzeck Endre Czeiter Krisztina Amrein Evgenios N. Kornaropoulos Jan Verheyden Gabriela Sugar Zhihui Yang Kevin Wang Andrew I. R. Maas Ewout Steyerberg András Büki Virginia F. J. Newcombe David K. Menon the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury Magnetic Resonance Imaging (CENTER-TBI MRI) Sub-study Participants and Investigators Serum biomarkers identify critically ill traumatic brain injury patients for MRI Critical Care Traumatic brain injury Traumatic axonal injury Diffuse axonal injury Magnetic resonance imaging Glasgow Coma Scale Serum protein biomarkers |
| title | Serum biomarkers identify critically ill traumatic brain injury patients for MRI |
| title_full | Serum biomarkers identify critically ill traumatic brain injury patients for MRI |
| title_fullStr | Serum biomarkers identify critically ill traumatic brain injury patients for MRI |
| title_full_unstemmed | Serum biomarkers identify critically ill traumatic brain injury patients for MRI |
| title_short | Serum biomarkers identify critically ill traumatic brain injury patients for MRI |
| title_sort | serum biomarkers identify critically ill traumatic brain injury patients for mri |
| topic | Traumatic brain injury Traumatic axonal injury Diffuse axonal injury Magnetic resonance imaging Glasgow Coma Scale Serum protein biomarkers |
| url | https://doi.org/10.1186/s13054-022-04250-3 |
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