TY - JOUR
T1 - Longitudinal Course of Traumatic Brain Injury Biomarkers for the Prediction of Clinical Outcomes
T2 - A Review
AU - Peters, Austin J.
AU - Schnell, Eric
AU - Saugstad, Julie A.
AU - Treggiari, Miriam M.
N1 - Funding Information:
Support for this study was provided in part by the Foundation for Anesthesia Education and Research (A.J.P.) . Support was also provided by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Biomedical Laboratory Research and Development Merit Review Award I01-BX002949 (E.S.), and a Department of Defense Congressionally Directed Medical Research Programs (CDMRP) Award W81XWH-18 − 1-0598 (E.S.). The contents of this article do not represent the views of the United States Department of Veterans Affairs or the United States Government.
Publisher Copyright:
© Copyright 2021, Mary Ann Liebert, Inc., publishers 2021.
PY - 2021/9/15
Y1 - 2021/9/15
N2 - Protein biomarkers are often measured at hospital presentation to diagnose traumatic brain injury (TBI) and predict patient outcomes. However, a biomarker measurement at this single time point is no more accurate at predicting patient outcomes than less invasive and more cost-effective methods. Here, we review evidence that TBI biomarkers provide greater prognostic value when measured repeatedly over time, such that a trajectory of biomarker concentrations can be evaluated. PubMed, Google Scholar, and Cochrane Central Register were searched to identify studies from the last decade in which established TBI biomarkers had been measured at more than one time point following acute TBI, and which related their findings to patient outcomes. Twenty-two studies were identified, 18 of which focused on adults and 4 of which focused on children. Three general biomarker trajectories were identified: persistently high, persistently low, and reversal of decreasing concentrations. Downtrend reversal was highly specific to predicting poor patient outcomes. Four studies demonstrated that biomarker trajectories can be affected by therapeutic interventions. Additional studies demonstrated that biomarkers measured at a later time point offered superior prognostic value than a single measurement obtained at initial hospital presentation. Among other details, longitudinal biomarker trajectory assessments may identify ongoing injury and predict patient deterioration before clinical symptoms develop and thus help guide therapeutic interventions.
AB - Protein biomarkers are often measured at hospital presentation to diagnose traumatic brain injury (TBI) and predict patient outcomes. However, a biomarker measurement at this single time point is no more accurate at predicting patient outcomes than less invasive and more cost-effective methods. Here, we review evidence that TBI biomarkers provide greater prognostic value when measured repeatedly over time, such that a trajectory of biomarker concentrations can be evaluated. PubMed, Google Scholar, and Cochrane Central Register were searched to identify studies from the last decade in which established TBI biomarkers had been measured at more than one time point following acute TBI, and which related their findings to patient outcomes. Twenty-two studies were identified, 18 of which focused on adults and 4 of which focused on children. Three general biomarker trajectories were identified: persistently high, persistently low, and reversal of decreasing concentrations. Downtrend reversal was highly specific to predicting poor patient outcomes. Four studies demonstrated that biomarker trajectories can be affected by therapeutic interventions. Additional studies demonstrated that biomarkers measured at a later time point offered superior prognostic value than a single measurement obtained at initial hospital presentation. Among other details, longitudinal biomarker trajectory assessments may identify ongoing injury and predict patient deterioration before clinical symptoms develop and thus help guide therapeutic interventions.
KW - Glasgow Coma Scale
KW - Glasgow Outcome Scale
KW - S100 calcium binding protein B
KW - biomarkers
KW - glial fibrillary acidic protein
KW - hypothermia
KW - trajectory
KW - traumatic brain injury
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U2 - 10.1089/neu.2020.7448
DO - 10.1089/neu.2020.7448
M3 - Review article
C2 - 33899510
AN - SCOPUS:85115606583
SN - 0897-7151
VL - 38
SP - 2490
EP - 2501
JO - Journal of neurotrauma
JF - Journal of neurotrauma
IS - 18
ER -