Blood biomarkers for brain injury in chronic subdural hematomas: postoperative dynamics and relation to long-term outcome.

IF 3.5 2区 医学 Q1 CLINICAL NEUROLOGY
Teodor Svedung Wettervik, Caroline Lindblad, Felix Axelsson, Christine Chidiac, Fernando Gonzalez-Ortiz, Kaj Blennow, Henrik Zetterberg, Jimmy Sundblom
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Abstract

Objective: The aim of this study was to investigate whether the biomarkers neuron-specific enolase (NSE), glial fibrillary acidic protein (GFAP), neurofilament light chain (NfL), and tau (total [t] and brain-derived [BD]) are elevated in plasma preoperatively; if there is a dynamic biomarker response to surgery; and if the biomarker levels are related to long-term outcome in chronic subdural hematomas (CSDHs).

Methods: Eighty-five CSDH patients surgically treated between 2022 and 2023 at Uppsala University Hospital, Uppsala, Sweden, were included in this prospective, observational study. NSE, GFAP, NfL, t-tau, and BD-tau were evaluated in plasma pre- and postoperatively (6-24 hours after surgery) and in the CSDH fluid. Health-related quality of life was evaluated using the 5-level EQ-5D (EQ-5D-5L) at 6 months postoperatively.

Results: GFAP, NfL, and tau levels decreased after CSDH surgery (p < 0.02). NSE and BD-tau levels also decreased, but not significantly. Older age and larger CSDH volume were associated with higher preoperative GFAP, NfL, and BD-tau levels (p < 0.05). Higher preoperative values and greater dynamics (Δ [postoperative value - preoperative value]) of GFAP, NfL, and BD-tau correlated significantly with worse levels of several EQ-5D-5L domains (p < 0.05). A higher preoperative NfL level in plasma was independently associated with a lower EQ-5D-5L visual analog scale score (p < 0.001).

Conclusions: Surgical CSDH patients exhibit ongoing central nervous system cellular injury, demonstrated via increased fluid biomarkers for brain injury preoperatively, which immediately improved after surgery and was strongly related to long-term outcome. The extent of preoperative biomarker elevation could aid in the decision-making for surgical indication and urgency.

慢性硬膜下血肿脑损伤的血液生物标志物:术后动态和与长期预后的关系。
目的:探讨术前血浆中生物标志物神经元特异性烯醇化酶(NSE)、胶质纤维酸性蛋白(GFAP)、神经丝轻链(NfL)和tau (total [t]和brain-derived [BD])是否升高;如果对手术有动态的生物标志物反应;以及生物标志物水平是否与慢性硬膜下血肿(CSDHs)的长期预后有关。方法:这项前瞻性观察性研究纳入了2022年至2023年期间在瑞典乌普萨拉大学医院接受手术治疗的85例CSDH患者。在术前、术后(术后6-24小时)和CSDH液中检测血浆中NSE、GFAP、NfL、t-tau和BD-tau。术后6个月采用5级EQ-5D (EQ-5D- 5l)评估健康相关生活质量。结果:CSDH术后GFAP、NfL、tau水平下降(p < 0.02)。NSE和BD-tau水平也有所下降,但不明显。年龄越大、CSDH体积越大与术前GFAP、NfL、BD-tau水平升高相关(p < 0.05)。GFAP、NfL和BD-tau术前值越高,动态越大(Δ[术后值-术前值]),与EQ-5D-5L的几个结构域水平越差相关(p < 0.05)。术前较高的血浆NfL水平与较低的EQ-5D-5L视觉模拟量表评分独立相关(p < 0.001)。结论:手术CSDH患者表现出持续的中枢神经系统细胞损伤,通过术前脑损伤液体生物标志物的增加证明,手术后立即改善,并与长期预后密切相关。术前生物标志物的升高程度有助于手术适应证和紧急程度的决策。
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来源期刊
Journal of neurosurgery
Journal of neurosurgery 医学-临床神经学
CiteScore
7.20
自引率
7.30%
发文量
1003
审稿时长
1 months
期刊介绍: The Journal of Neurosurgery, Journal of Neurosurgery: Spine, Journal of Neurosurgery: Pediatrics, and Neurosurgical Focus are devoted to the publication of original works relating primarily to neurosurgery, including studies in clinical neurophysiology, organic neurology, ophthalmology, radiology, pathology, and molecular biology. The Editors and Editorial Boards encourage submission of clinical and laboratory studies. Other manuscripts accepted for review include technical notes on instruments or equipment that are innovative or useful to clinicians and researchers in the field of neuroscience; papers describing unusual cases; manuscripts on historical persons or events related to neurosurgery; and in Neurosurgical Focus, occasional reviews. Letters to the Editor commenting on articles recently published in the Journal of Neurosurgery, Journal of Neurosurgery: Spine, and Journal of Neurosurgery: Pediatrics are welcome.
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