Correlation of serum biomarkers with clinicoradiological assessments in patients with moderate and severe traumatic brain injury.

Abstract

Objective: Despite advancements in traumatic brain injury (TBI) management and the development of standardized care guidelines, mortality and morbidity rates remain high. Current diagnostic and prognostic tools are limited, particularly in resource-constrained settings. This study investigated the potential role of serum biomarkers, including glial fibrillary acidic protein (GFAP), neuron-specific enolase (NSE), and S100β protein, in assessing the clinical severity and outcomes of patients with moderate and severe TBI in a Nigerian trauma center.

Methods: This prospective, single-center study included 44 patients with moderate and severe TBI admitted to the National Hospital Abuja, Nigeria, from November 5, 2019, to November 4, 2020. Clinical and radiological data were documented, and serum levels of GFAP, NSE, and S100β protein were measured at admission, as well as 3 and 7 days postinjury, using enzyme-linked immunosorbent assay kits. Treatment outcomes were assessed using the Glasgow Outcome Scale at 3 months post-TBI.

Results: At admission, mean serum levels of GFAP (1.85 ± 1.12 ng/ml), NSE (14.25 ± 2.77 ng/ml), and S100β protein (0.60 ± 0.20 ng/ml) were elevated beyond normal reference values. Serum levels were significantly higher in patients with severe TBI compared with those with moderate TBI (p < 0.05). An inverse relationship was observed between serum biomarker levels and Glasgow Coma Scale scores, with patients experiencing unfavorable outcomes exhibiting higher biomarker levels. Additionally, GFAP and NSE showed an inverse correlation with the Rotterdam CT score within 24 hours of admission, while S100β protein demonstrated a direct correlation. The area under the curve for GFAP was the highest at 0.828, compared with 0.759 for NSE and 0.750 for S100β protein.

Conclusions: Among the biomarkers studied, S100β protein showed a superior correlation with radiological findings, whereas GFAP demonstrated the most reliable predictive ability for prognosticating outcomes in patients with moderate and severe TBI.