Neuroanesthesia & neurocritical care
Diagnostic Performance of Glial Fibrillary Acidic Protein (GFAP), UCH-L1, and MAP-2 Within 30 and 60 Minutes of Traumatic Brain Injury
Authors' conclusion
In this cohort study of prehospital patients with TBI, GFAP, UCH-L1, and MAP-2 measured within 30 and 60 minutes of injury were significantly associated with traumatic intracranial lesions and diffuse injury severity on CT scan, 24-hour NSI, and 7-day CIEO. GFAP was the strongest independent marker associated with all outcomes.
Study context
- Population
- Prehospital hemodynamically stable adults with traumatic injury and suspected moderate to severe traumatic brain injury (TBI), 20 centres and 39 EMS systems in North America, 2015–2017with blood samples
- Participants
- 804 adults
- Comparison
- GFAP vs UCH-L1 vs MAP-2 measured within 30 and 60 minutes of TBI
- Outcome
- CT lesions, diffuse injury severity on CT, NSI within 24 hours, and CIEO (early death, neurosurgery, or mechanical ventilation ≥7 days) within 7 days
Methodological detailsbiomarker analysis of a prehospital trial cohort, multicentre
- Biomarker analysis of a prehospital trial cohort
- Multicentre
Performance
As reported in the abstract
CT lesions, blood within 30 minutes · within 30 minutes of injury
| Test or model | AUC |
|---|---|
| GFAP | 0.88 (95% CI, 0.85-0.92) |
| MAP-2 | 0.78 (95% CI, 0.73-0.83) |
| UCH-L1 | 0.75 (95% CI, 0.70-0.80) |
AUC
GFAP0.88 (95% CI, 0.85-0.92)
MAP-20.78 (95% CI, 0.73-0.83)
UCH-L10.75 (95% CI, 0.70-0.80)
Further findings
| Outcome | GFAP | UCH-L1 | MAP-2 |
|---|---|---|---|
| CT lesions, blood within 60 minutes · within 60 minutes of injury | |||
| AUC | 0.89 (95% CI, 0.86-0.92) | 0.73 (95% CI, 0.69-0.77) | 0.76 (95% CI, 0.72-0.80) |
| NSI, blood within 30 minutes · within 30 minutes of injury | |||
| AUC | 0.78 (95% CI, 0.72-0.84) | 0.69 (95% CI, 0.63-0.75) | 0.75 (95% CI, 0.68-0.81) |
| CIEO, blood within 30 minutes · within 30 minutes of injury | |||
| AUC | 0.89 (95% CI, 0.85-0.93) | 0.77 (95% CI, 0.72-0.82) | 0.83 (95% CI, 0.78-0.87) |
- GFAP 30 pg/mL cutoff for computed tomography (CT) lesions, within 30 minutes · within 30 minutes of injury
- 98.1% (95% CI, 94.9%-99.4%) · sensitivity · specificity 34.4% (95% CI, 27.2%-42.2%)
- CT lesions, blood within 60 minutes: 563 with blood within 60 minutes; 316 (56.1%) had CT lesions
- Neurosurgical intervention (NSI), blood within 30 minutes: 61 (16.3%) had NSI
- Clinically important early outcomes (CIEO), blood within 30 minutes: 112 (30.0%) had CIEO
Diffuse injury severity on CT and high-risk GFAP threshold
- All biomarkers significantly elevated with worsening diffuse injury on CT within 30 and 60 minutes
- GFAP >6200 pg/mL associated with high risk of NSI and CIEO
Original publication
Diagnostic Performance of GFAP, UCH-L1, and MAP-2 Within 30 and 60 Minutes of Traumatic Brain Injury. JAMA Netw Open. Published 3 September 2024. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →