Blood tests in newly brain-injured patients predict death and severe disability

According to a study led by UC San Francisco, the University of Pennsylvania and the University of Michigan. Their results – available in minutes – can confirm the need for quick surgeries or can help guide conversations with families in the event of a devastating injury.

Modern trauma care can work well in what we once thought were non-survivable injuries.

Geoffrey Manley, MD, Ph.D.

The tests, which detect two protein biomarkers, were cleared by the Food and Drug Administration in 2018 for use in determining which patients with mild TBI should undergo CT scans. Elevated values ​​of these biomarkers, GFAP and UCH-L1, correlate with death and serious injury, say the authors in their study published in The Lancet Neurology on August 10, 2022.

The study’s co-lead author, Geoffrey Manley, MD, PhD, professor and vice president of neurosurgery at UCSF, said these blood tests are “both diagnostic and prognostic,” as well as easy to perform. administer, fast and inexpensive.

In the study, researchers from TRACK-TBI, a UCSF-led brain injury research initiative, looked at the day-of-injury blood tests of 1,696 patients with TBI, using the ‘Abbott i-STAT Alinity, a portable blood analyzer, and ARCHITECT assays. The results of these blood tests were compared during patient assessments at six months, using the Glasgow Outcome Scale Extended, which assesses outcomes and quantifies levels of disability after TBI. These outcomes range from death (level 1) to complete recovery with resumption of normal life but minor deficits in some cases (level 8).

1 in 5 patients died or had severe disabilities

About two-thirds of the patients were men, and their average age was 39. They had been evaluated at 18 Level 1 trauma centers for injuries caused primarily by traffic accidents or falls. Six months after injury, 7% of patients had died, 14% had an “unfavorable course”, with level 2-4 injuries ranging from vegetative to severe disability requiring daily support. The remaining 67% had “incomplete recovery” ranging from moderate disabilities requiring assistance outside the home to minor disabling neurological or psychological deficits.

This CT scan shows severe brain damage. A simple blood test can more accurately predict whether the patient will die or survive with severe disabilities. Image provided by UCSF

The researchers found that day-of-injury blood tests had a high probability of predicting death at six months, 87% for GFAP and 89% for UCH-L1; and a high probability of predicting severe disability at the same time, 86% for GFAP and UCH-L1. But they were significantly less accurate in predicting incomplete recovery compared to complete recovery: 62% and 61%, respectively.

“We believe this tool may encourage clinicians to be more aggressive in their decisions to start or continue lifesaving treatment,” said Manley, principal investigator of TRACK-TBI and fellow at the UCSF Weill Institute for Neurosciences. “Modern trauma care can work well in what we once thought were non-survivable injuries.”

Blood tests can also guide discussions with families in catastrophic injury cases, he said, and help in “mass casualty situations where they can play a critical role in triage and resource allocation.” “.

This study is the “first report on the accuracy of a blood test that can be obtained rapidly on the day of injury in predicting neurological recovery six months after injury,” said first author Frederick Korley, MD, PhD, professor associate degree in emergency medicine. at the University of Michigan. “Although there have been previous prognostic studies, they have used a limited number of patients, which may result in imprecise estimates.”

Prognostic models add to the accuracy of blood tests

The researchers wanted to see if the accuracy of predicting outcomes would be improved if the two blood tests were done together and combined with prognostic models that looked at variables such as age, motor score, pupil reactivity and characteristics. CT. They found that in patients with severe and moderate head trauma, the accuracy of predicting death and severe disability increased to 94% and 89%, respectively. But in patients with mild TBI, the likelihood of predicting complete versus incomplete recovery only increased to 69%.

Structural brain injury detected by CT and MRI has been reported as an independent predictor of moderate and mild disability risk in mild TBI, noted co-lead author Ramon Diaz-Arrastia, MD, PhD, Professor of neurology at the University of Pennsylvania’s Perelman School of Medicine and director of the Traumatic Brain Injury Clinical Research Center at Penn Presbyterian Medical Center.

“Therefore, although structural brain injury, as measured by GFAP and UCH-L1, as well as CT scan, may play a predominant role in determining a poor outcome in moderate and severe TBI, the mechanisms of injury related to poor outcome after mild TBI are not yet fully understood,” Diaz-Arrastia said, noting that further study would be needed to replicate these findings.

TBI is a heterogeneous condition that requires a “rich and diverse dataset like that of the TRACK-TBI study,” said Nsini Umoh, PhD, program director for the Division of Neuroscience at the National Institute of Neurological Disorders. and Stroke, which funded the study. “One of the goals of TRACK-TBI is to develop better prognostic tools for TBI patients, which could help predict the trajectory of recovery and inform treatment options.”

Co-authors: For a full list of authors, please refer to the study.

Funding: TRACK-TBI is sponsored by the US National Institutes of Health, National Institute of Neurologic Disorders and Stroke (Grant # U01 NS1365885), US Department of Defense; Abbott Laboratories, One Mind.

Disclosures: Frederick Korley, MD, PhD consulted and received research funding from Abbott Laboratories.

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