• Iftakher Hossain, Mehrbod Mohammadian, Takala Riikka S K RSK 2 Turku Brain Injury Center, Turku University Hospital, Turku, Finland. 4 Perioper, Olli Tenovuo, Linnéa Lagerstedt, Henna Ala-Seppälä, Janek Frantzén, Mark van Gils, Peter Hutchinson, Ari J Katila, Henna-Riikka Maanpää, David K Menon, Virginia F Newcombe, Jussi Tallus, Kevin Hrusovsky, David H Wilson, Kaj Blennow, Jean-Charles Sanchez, Henrik Zetterberg, and Jussi P Posti.
• 1 Department of Neurosurgery, Turku University Hospital, Turku, Finland.
• J. Neurotrauma. 2019 May 15; 36 (10): 1551-1560.

AbstractThe purpose of this study was to correlate the early levels of glial fibrillary acidic protein (GFAP) and neurofilament light protein (NF-L) with outcome in patients with mild traumatic brain injury (mTBI). A total of 107 patients with mTBI (Glasgow Coma Scale ≥13) who had blood samples for GFAP and NF-L available within 24 h of arrival were included. Patients with mTBI were divided into computed tomography (CT)-positive and CT-negative groups. Glasgow Outcome Scale-Extended (GOSE) was used to assess the outcome. Outcomes were defined as complete (GOSE 8) versus incomplete (GOSE <8), and favorable (GOSE 5-8) versus unfavorable (GOSE 1-4). GFAP and NF-L concentrations in blood were measured using ultrasensitive single molecule array technology. Patients with incomplete recovery had significantly higher levels of NF-L compared with those with complete recovery (p = 0.005). The levels of GFAP and NF-L were significantly higher in patients with unfavorable outcome than in patients with favorable outcome (p = 0.002 for GFAP and p < 0.001 for NF-L). For predicting favorable outcome, the area under the receiver operating characteristic curve for GFAP and NF-L was 0.755 and 0.826, respectively. In a multi-variate logistic regression model, the level of NF-L was still a significant predictor for complete recovery (odds ratio [OR] = 1.008; 95% confidence interval [CI], 1.000-1.016). Moreover, the level of NF-L was a significant predictor for complete recovery in CT-positive patients (OR = 1.009; 95% CI, 1.001-1.016). The early levels of GFAP and NF-L are significantly correlated with the outcome in patients with mTBI. The level of NF-L within 24 h from arrival has a significant predictive value in mTBI also in a multi-variate model.

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