Acute-Phase Neurofilament Light and Glial Fibrillary Acidic Proteins in Cerebrospinal Fluid Predict Long-Term Outcome After Severe Traumatic Brain Injury.

IF 3.1 3区医学 Q2 CLINICAL NEUROLOGY

Neurocritical Care Pub Date : 2024-12-01 Epub Date: 2024-05-20 DOI:10.1007/s12028-024-01998-0

Emma Andersson, Martin Öst, Keti Dalla, Henrik Zetterberg, Kaj Blennow, Bengt Nellgård

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Abstract

Background: This study investigated trajectory profiles and the association of concentrations of the biomarkers neurofilament light (NfL) and glial fibrillary acidic protein (GFAP) in ventricular cerebrospinal fluid (CSF) with clinical outcome at 1 year and 10-15 years after a severe traumatic brain injury (sTBI).

Methods: This study included patients with sTBI at the Neurointensive Care Unit at Sahlgrenska University Hospital, Gothenburg, Sweden. The injury was regarded as severe if patients had a Glasgow Coma Scale ≤ 8 corresponding to Reaction Level Scale ≥ 4. CSF was collected from a ventricular catheter during a 2-week period. Concentrations of NfL and GFAP in CSF were analyzed with enzyme-linked immunosorbent assay. The Glasgow Outcome Scale (GOS) was used to assess the 1-year and 10-15-year outcomes. After adjustment for age and previous neurological diseases, logistic regression was performed for the outcomes GOS 1 (dead) or GOS 2-5 (alive) and GOS 1-3 (poor) or GOS 4-5 (good) versus the independent continuous variables (NfL and GFAP).

Results: Fifty-three patients with sTBI were investigated; forty-seven adults are presented in the article, and six children (aged 7-18 years) are described in Supplement 1. The CSF concentrations of NfL gradually increased over 2 weeks post trauma, whereas GFAP concentrations peaked on days 3-4. Increasing NfL and GFAP CSF concentrations increased the odds of GOS 1-3 outcome 1 year after trauma (odds ratio [OR] 1.73, 95% confidence interval [CI] 1.07-2.80, p = 0.025; and OR 1.61, 95% CI 1.09-2.37, p = 0.016, respectively). Similarly, increasing CSF concentrations of NfL and GFAP increased the odds for GOS 1-3 outcome 10-15 years after trauma (OR 2.04, 95% CI 1.05-3.96, p = 0.035; and OR 1.60, 95% CI 1.02-2.00, p = 0.040).

Conclusions: This study shows that initial high concentrations of NfL and GFAP in CSF are both associated with higher odds for GOS 1-3 outcome 1 year and 10-15 years after an sTBI, implicating its potential usage as a prognostic marker in the future.

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脑脊液中的急性期神经丝蛋白和胶质纤维酸性蛋白可预测严重创伤性脑损伤后的长期预后。

研究背景本研究调查了严重创伤性脑损伤（sTBI）后1年和10-15年脑室脑脊液（CSF）中生物标志物神经丝光（NfL）和神经胶质纤维酸性蛋白（GFAP）的轨迹特征和浓度与临床结果的关系：研究对象包括瑞典哥德堡萨赫格伦斯卡大学医院神经重症监护室的严重创伤性脑损伤患者。如果患者的格拉斯哥昏迷量表（Glasgow Coma Scale）≤8，反应程度量表（Reaction Level Scale）≥4，则被视为重伤。在两周内从脑室导管中收集脑脊液。用酶联免疫吸附试验分析 CSF 中 NfL 和 GFAP 的浓度。格拉斯哥结果量表（GOS）用于评估1年和10-15年的结果。在对年龄和既往神经系统疾病进行调整后，对GOS 1（死亡）或GOS 2-5（存活）、GOS 1-3（差）或GOS 4-5（好）与独立连续变量（NfL和GFAP）的结果进行了逻辑回归：对 53 名 sTBI 患者进行了调查；文章中介绍了 47 名成人，补充 1 中介绍了 6 名儿童（7-18 岁）。NfL的脑脊液浓度在创伤后两周内逐渐升高，而GFAP的浓度则在第3-4天达到峰值。NfL和GFAP CSF浓度的增加会增加创伤后1年出现GOS 1-3结果的几率（几率比[OR]分别为1.73，95%置信区间[CI]为1.07-2.80，p = 0.025；和OR分别为1.61，95%置信区间[CI]为1.09-2.37，p = 0.016）。同样，NfL和GFAP的CSF浓度增加会增加创伤后10-15年GOS 1-3结果的几率（OR 2.04，95% CI 1.05-3.96，p = 0.035；OR 1.60，95% CI 1.02-2.00，p = 0.040）：本研究表明，CSF中初始高浓度的NfL和GFAP均与创伤性脑损伤1年后和10-15年后出现GOS 1-3结果的几率较高有关，这意味着其在未来有可能被用作预后标志物。

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来源期刊

Neurocritical Care 医学-临床神经学

CiteScore

7.40

自引率

8.60%

发文量

221

审稿时长

4-8 weeks

期刊介绍： Neurocritical Care is a peer reviewed scientific publication whose major goal is to disseminate new knowledge on all aspects of acute neurological care. It is directed towards neurosurgeons, neuro-intensivists, neurologists, anesthesiologists, emergency physicians, and critical care nurses treating patients with urgent neurologic disorders. These are conditions that may potentially evolve rapidly and could need immediate medical or surgical intervention. Neurocritical Care provides a comprehensive overview of current developments in intensive care neurology, neurosurgery and neuroanesthesia and includes information about new therapeutic avenues and technological innovations. Neurocritical Care is the official journal of the Neurocritical Care Society.