Citation

Defazio MV, Rammo RA, Robles JR, Bramlett HM, Dietrich WD, Bullock MR. World Neurosurg. 2014; 81(1): 151-158.

Affiliation

Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida.

Copyright

(Copyright © 2014, Elsevier Publishing)

DOI

10.1016/j.wneu.2013.01.015

PMID

23313262

Abstract

OBJECTIVE: Severe traumatic brain injury (TBI) is a dynamic neuropathological process with a substantial proportion of deaths occurring within the first 48-hours. The assessment of injury severity and prognosis are of primary concern in the initial management of severe TBI. Supplemental testing that aids in the stratification of patients at high risk for deterioration may significantly improve posttraumatic management in the acute setting. METHODS: This retrospective study assessed the utility of both single-marker and multi-marker models as predictive indicators of acute clinical status following severe TBI. Forty-four patients who sustained severe TBI (admission GCS ≤8) were divided into two cohorts according to a dichotomized clinical outcome at 72-hours post-admission: Poor Status (death or GCS ≤8) and Improved Status (GCS improved to >8). Threshold values for clinical status prediction were calculated for serum S-100B, MMP-9, and plasma D-Dimer, upon admission and at 24-hours post-TBI, using ROC analysis. Performance characteristics of these single marker predictors were compared with those derived from a multi-marker logistic regression analysis. RESULTS: Biomarkers with the greatest predictive value for poor status at 72-hours included serum S-100B on admission, as well as plasma D-Dimer and serum S-100B at 24-hours, for which, associations were strongly significant. Multi-marker analysis indicated no substantial improvement in prediction accuracy over the best single predictors during this time frame. CONCLUSION: In conjunction with other clinical, physical, and radiologic evidence, blood-derived biochemical markers may serve to enhance prediction of early clinical trends following severe TBI.

Language: en