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Serum biomarkers identify critically ill traumatic brain injury patients for MRI

2022; BioMed Central; Volume: 26; Issue: 1 Linguagem: Inglês

10.1186/s13054-022-04250-3

1466-609X

Sophie Richter, Stefan Winzeck, Endre Czeiter, Krisztina Amrein, Evgenios Kornaropoulos, Jan Verheyden, Gabriela Sugar, Zhihui Yang, Kevin Wang, Andrew I.R. Maas, Ewout W. Steyerberg, András Büki, Virginia Newcombe, David Menon, Krisztina Amrein, Nada Anđelić, Lasse Andreassen, Audny Anke, Philippe Azouvi, Bo‐Michael Bellander, Habib Benali, András Büki, Alessio Caccioppola, Emiliana Calappi, Marco Carbonara, Giuseppe Citerio, Hans Clusmann, Mark Coburn, Jonathan Coles, Marta Correia, Endre Czeiter, Véronique De Keyser, Vincent Degos, Bart Depreitere, Live Eikenes, Erzsébet Ezer, Kelly Foks, Shirin Frisvold, Damien Galanaud, Alexandre Ghuysen, Ben Glocker, Asta K. Håberg, Iain Haitsma, Eirik Helseth, Peter J. Hutchinson, Evgenios Kornaropoulos, Noémi Kovács, Ana Kowark, Steven Laureys, Didier Ledoux, Hester F. Lingsma, Andrew I.R. Maas, Geoffrey T. Manley, David Menon, Tomas Menovsky, Benoît Misset, Visakh Muraleedharan, Ingeborg Nakken, Virginia Newcombe, Wibeke Nordhøy, József Nyirádi, Fabrizio Ortolano, Paul M. Parizel, Vincent Perlbarg, Paolo Persona, Wilco C. Peul, Jussi P. Posti, Louis Puybasset, Sophie Richter, Cecilie Røe, Olav Røise, Rolf Rossaint, Sandra Rossi, Daniel Rueckert, Toril Skandsen, Abayomi Sorinola, Emmanuel A. Stamatakis, Ewout W. Steyerberg, Nino Stocchetti, Riikka Takala, Viktória Tamás, Olli Tenovuo, Zoltán Vámos, Gregory Van der Steen, Wim Van Hecke, Thijs Vande Vyvere, Jan Verheyden, Anne Vik, Victor Volovici, Lars T. Westlye, Guy Williams, Stefan Winzeck, Peter Ylén, Tommaso Zoerle,

Medical Imaging Techniques and Applications

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.