Brain injury biomarkers may improve the predictive power of the IMPACT outcome calculator

Endre Czeiter, Stefania Mondello, Noemi Kovacs, J. Sándor, Andrea Gabrielli, Kara Schmid, Frank Tortella, Kevin K W Wang, Ronald L. Hayes, P. Barzó, Erzsebet Ezer, T. Dóczi, A. Büki

Research output: Contribution to journalArticle

75 Citations (Scopus)

Abstract

Outcome prediction following severe traumatic brain injury (sTBI) is a widely investigated field of research. A major breakthrough is represented by the IMPACT prognostic calculator based on admission data of more than 8500 patients. A growing body of scientific evidence has shown that clinically meaningful biomarkers, including glial fibrillary acidic protein (GFAP), ubiquitin C-terminal hydrolase-L1 (UCH-L1), and αII-spectrin breakdown product (SBDP145), could also contribute to outcome prediction. The present study was initiated to assess whether the addition of biomarkers to the IMPACT prognostic calculator could improve its predictive power. Forty-five sTBI patients (GCS score≤8) from four different sites were investigated. We utilized the core model of the IMPACT calculator (age, GCS motor score, and reaction of pupils), and measured the level of GFAP, UCH-L1, and SBDP145 in serum and cerebrospinal fluid (CSF). The forecast and actual 6-month outcomes were compared by logistic regression analysis. The results of the core model itself, as well as serum values of GFAP and CSF levels of SBDP145, showed a significant correlation with the 6-month mortality using a univariate analysis. In the core model, the Nagelkerke R 2 value was 0.214. With multivariate analysis we were able to increase this predictive power with one additional biomarker (GFAP in CSF) to R 2=0.476, while the application of three biomarker levels (GFAP in CSF, GFAP in serum, and SBDP145 in CSF) increased the Nagelkerke R 2 to 0.700. Our preliminary results underline the importance of biomarkers in outcome prediction, and encourage further investigation to expand the predictive power of contemporary outcome calculators and prognostic models in TBI.

Original languageEnglish
Pages (from-to)1770-1778
Number of pages9
JournalJournal of Neurotrauma
Volume29
Issue number9
DOIs
Publication statusPublished - Jun 10 2012

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Glial Fibrillary Acidic Protein
Brain Injuries
Biomarkers
Cerebrospinal Fluid
Ubiquitin Thiolesterase
Protein C
Serum
Spectrin
Pupil
Multivariate Analysis
Logistic Models
Regression Analysis
Mortality
Research

Keywords

  • biomarkers
  • IMPACT calculator
  • outcome
  • prognostic models
  • traumatic brain injury

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Brain injury biomarkers may improve the predictive power of the IMPACT outcome calculator. / Czeiter, Endre; Mondello, Stefania; Kovacs, Noemi; Sándor, J.; Gabrielli, Andrea; Schmid, Kara; Tortella, Frank; Wang, Kevin K W; Hayes, Ronald L.; Barzó, P.; Ezer, Erzsebet; Dóczi, T.; Büki, A.

In: Journal of Neurotrauma, Vol. 29, No. 9, 10.06.2012, p. 1770-1778.

Research output: Contribution to journalArticle

Czeiter, E, Mondello, S, Kovacs, N, Sándor, J, Gabrielli, A, Schmid, K, Tortella, F, Wang, KKW, Hayes, RL, Barzó, P, Ezer, E, Dóczi, T & Büki, A 2012, 'Brain injury biomarkers may improve the predictive power of the IMPACT outcome calculator', Journal of Neurotrauma, vol. 29, no. 9, pp. 1770-1778. https://doi.org/10.1089/neu.2011.2127
Czeiter, Endre ; Mondello, Stefania ; Kovacs, Noemi ; Sándor, J. ; Gabrielli, Andrea ; Schmid, Kara ; Tortella, Frank ; Wang, Kevin K W ; Hayes, Ronald L. ; Barzó, P. ; Ezer, Erzsebet ; Dóczi, T. ; Büki, A. / Brain injury biomarkers may improve the predictive power of the IMPACT outcome calculator. In: Journal of Neurotrauma. 2012 ; Vol. 29, No. 9. pp. 1770-1778.
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