The use of blood biomarkers in the detection and management of traumatic brain injury
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Abstract
This thesis explores the evolving landscape of blood and serum biomarkers in the detection and management of traumatic brain injury (TBI) and highlights the potential for these biomarkers to revolutionize current practices. TBI, a leading cause of morbidity and mortality globally, presents significant challenges in diagnosis and management owing to its complex pathophysiology and limitations in current imaging techniques. Recent advances in biomarker research have opened new avenues for improving TBI diagnostics and prognostics with the hope of leading to better therapeutic strategies. This review focuses on the diagnostic accuracy, prognostic value, and potential utility in guiding treatment decisions for five primary biomarkers: S100 Calcium-Binding Protein B (S100B), Glial fibrillary acidic protein (GFAP), ubiquitin C-terminal hydrolase L1 (UCH-L1), neurofilament light chain (NF-L), and Tau.S100B, a glial protein, has been extensively studied for its role in the acute phase of TBI, offering valuable insights into injury severity and patient outcomes. GFAP and UCH-L1 similarly provide information on glial and neuronal damage, respectively, further enriching the biomarker toolkit for TBI assessment. Neurofilament proteins (NF) and Tau, both associated with axonal injury, have emerged as promising indicators of neurodegeneration, offering prognostic information and a window into the chronic effects of TBI. Looking ahead, inflammatory markers, extracellular vesicles (EV), and microRNAs are identified as promising candidates for TBI biomarker research. These novel biomarkers hold the potential for even more precise diagnosis, understanding the complex biological responses to TBI, and tailoring individualized management plans.
While many of these biomarkers hold promise, GFAP stands above them. With well-validated diagnostic capabilities and defined cutoff values for TBI patients, it currently has the most potential for clinical use and has been approved for use by the U.S. Food and Drug Administration (FDA) in a biomarker panel alongside UCH-L1 to screen patients who may require a head computerized tomography (CT) scan based on biomarker levels. S100B has also been suggested for use as diagnostic criteria to determine a patient’s eligibility for head CT through the establishment and validation of the Scandinavian Guidelines. Further experimentation is necessary to fully validate NF and Tau for diagnostic capabilities, but a lack of clinically relevant cutoff values holds most other biomarkers back in their usefulness for diagnostics. While there does seem to be a significant place for most biomarkers in outcome monitoring and prediction, blood biomarker sampling currently only has enough evidence to slightly impact treatment decisions. However, although they have not been widely implemented, the use of blood biomarkers as a criterion for head CT scans has already lowered the number of unnecessary head CT scans performed and will continue to improve with further research.
Description
2024
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Attribution 4.0 International