Effect of blood alcohol on the diagnostic accuracy of glial fibrillary acidic protein and ubiquitin carboxy-terminal hydrolase L1 for traumatic intracranial hemorrhage: A TRACK-TBI study.

IF 3.2 3区医学 Q1 EMERGENCY MEDICINE

Academic Emergency Medicine Pub Date : 2025-07-01 Epub Date: 2025-02-18 DOI:10.1111/acem.15109

Mark Harris, John K Yue, Sonia Jain, Xiaoying Sun, Ava M Puccio, Raquel C Gardner, Kevin K W Wang, David O Okonkwo, Esther L Yuh, Pratik Mukherjee, Lindsay D Nelson, Sabrina R Taylor, Amy J Markowitz, Ramon Diaz-Arrastia, Geoffrey T Manley, Frederick K Korley

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引用次数: 0

Abstract

Background: Acute intoxication is common in patients evaluated for traumatic brain injury (TBI). However, the effect of elevated blood alcohol levels (BALs) on the diagnostic accuracy of FDA-cleared biomarkers for evaluating traumatic intracranial injury on computed tomography (CT) scan, namely, glial fibrillary acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), has not been well studied.

Methods: We investigated the effect of significantly elevated (>300 mg/dL) and modestly elevated BAL (81-300 mg/dL) at emergency department presentation on the diagnostic accuracy of GFAP and UCH-L1 for predicting a positive CT in patients presenting to 18 U.S. Level I trauma centers within 24 h of TBI as part of the prospective, Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study. Plasma GFAP and UCH-L1 were measured using Abbott i-STAT Alinity and ARCHITECT assays. Discrimination was evaluated using the area under the receiver operating characteristic curve (AUC).

Results: Of 2320 TRACK-TBI participants studied, 54 (2.3%), 332 (14.3%), 1209 (52.1%), and 725 (31.3%) had significantly elevated BAL, modestly elevated BAL, nonelevated BAL (0-80 mg/dL), and no BAL available, respectively; 48.3% of the cohort had a positive brain CT. Those with significantly elevated and modestly elevated BAL were more likely to have positive CT (61.1% and 60.5% vs. 46.9% and 44.0%) and had higher plasma GFAP and UCH-L1 levels than those with nonelevated BAL and no BAL available. The AUC of GFAP and UCH-L1 combined for predicting CT positivity was higher in those with significantly elevated BAL (0.949) than those with modestly elevated BAL (0.858), nonelevated BAL (0.849), and no BAL available (0.883).

Conclusions: Modestly and significantly elevated BAL does not lower the diagnostic accuracy of GFAP and UCH-L1 for predicting traumatic intracranial injury on CT. These biomarkers may be useful in decreasing avoidable brain CT imaging in persons with acute alcohol intoxication.

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血液酒精对神经胶质纤维酸性蛋白和泛素羧基末端水解酶L1诊断外伤性颅内出血准确性的影响：一项TRACK-TBI研究

背景：急性中毒在创伤性脑损伤（TBI）患者中很常见。然而，血液酒精水平升高（BALs）对fda批准的计算机断层扫描（CT）评估外伤性颅内损伤的生物标志物，即胶质纤维酸性蛋白（GFAP）和泛素羧基末端水解酶L1 （UCH-L1）的诊断准确性的影响尚未得到很好的研究。方法：我们研究了急诊科就诊时显著升高（>300 mg/dL）和中度升高BAL （81-300 mg/dL）对GFAP和UCH-L1预测CT阳性的准确性的影响作为TBI前瞻性、转化研究和临床知识（TRACK-TBI）研究的一部分，TBI后24小时内的一级创伤中心。采用Abbott i-STAT Alinity和ARCHITECT检测血浆GFAP和UCH-L1。用受试者工作特征曲线下面积（AUC）评价鉴别。结果：在研究的2320名TRACK-TBI参与者中，分别有54名（2.3%）、332名（14.3%）、1209名（52.1%）和725名（31.3%）BAL显著升高、BAL中度升高、BAL非升高（0-80 mg/dL）和无BAL可用；48.3%的患者脑CT呈阳性。BAL显著升高和中度升高的患者更有可能出现CT阳性（61.1%和60.5% vs. 46.9%和44.0%），血浆GFAP和UCH-L1水平高于BAL未升高和无BAL的患者。GFAP和UCH-L1联合预测CT阳性的AUC在BAL显著升高组（0.949）高于BAL中度升高组（0.858）、BAL未升高组（0.849）和无BAL可用组（0.883）。结论：中度和显著升高的BAL并不会降低GFAP和UCH-L1在CT上预测外伤性颅内损伤的诊断准确性。这些生物标志物可能有助于减少急性酒精中毒患者可避免的脑CT成像。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Academic Emergency Medicine 医学-急救医学

CiteScore

7.60

自引率

6.80%

发文量

207

审稿时长

3-8 weeks

期刊介绍： Academic Emergency Medicine (AEM) is the official monthly publication of the Society for Academic Emergency Medicine (SAEM) and publishes information relevant to the practice, educational advancements, and investigation of emergency medicine. It is the second-largest peer-reviewed scientific journal in the specialty of emergency medicine. The goal of AEM is to advance the science, education, and clinical practice of emergency medicine, to serve as a voice for the academic emergency medicine community, and to promote SAEM''s goals and objectives. Members and non-members worldwide depend on this journal for translational medicine relevant to emergency medicine, as well as for clinical news, case studies and more. Each issue contains information relevant to the research, educational advancements, and practice in emergency medicine. Subject matter is diverse, including preclinical studies, clinical topics, health policy, and educational methods. The research of SAEM members contributes significantly to the scientific content and development of the journal.