胶质纤维酸性蛋白
创伤性脑损伤
医学
队列
头部受伤
头部外伤
内科学
损伤严重程度评分
格拉斯哥结局量表
胃肠病学
病理
麻醉
外科
毒物控制
伤害预防
免疫组织化学
环境卫生
精神科
作者
Kimberly Lumpkins,Grant V. Bochicchio,Kaspar Keledjian,J. Marc Simard,Maureen McCunn,Thomas M. Scalea
出处
期刊:Journal of Trauma-injury Infection and Critical Care
[Ovid Technologies (Wolters Kluwer)]
日期:2008-10-01
卷期号:65 (4): 778-784
被引量:151
标识
DOI:10.1097/ta.0b013e318185db2d
摘要
Background: Glial fibrillary acidic protein (GFAP) is an intermediate filament protein found in the cytoskeleton of astroglia. Recent work has indicated that GFAP may serve as a serum marker of traumatic brain injury (TBI) that is released after central nervous system cell damage. Methods: Serum from 51 critically injured trauma patients was prospectively collected on admission and on hospital day 2. All patients underwent an admission head computed tomography (CT) scan as a part of their clinical evaluation. Patients with facial fractures in the absence of documented TBI and patients with spinal cord injury were excluded. Demographic and outcome data were collected prospectively. Serum GFAP was measured in duplicate using enzyme-linked immunosorbent assay techniques. Results: Thirty-nine (76%) of the 51 patients had CT-documented TBI. The study cohort was 72.5% men with a mean age of 43 years and mean Injury Severity Score (ISS) of 30.2. There were no statistically significant demographic differences between the two groups. At admission day, the mean GFAP level in non-TBI patients was 0.07 pg/mL compared with 6.77 pg/mL in TBI patients (p = 0.002). On day 2 the mean GFAP level was 0.02 in non-TBI patients compared with 2.17 in TBI patients (p = 0.003). Using regression analysis to control for age, sex, and ISS, the Head Abbreviated Injury Scale was predictive of the level of GFAP on both days 1 and 2 (p values 0.006 and 0.026, respectively). Although GFAP levels were not predictive of increased hospital length of stay, intensive care unit length of stay, or ventilator days, high GFAP levels on hospital day 2 were predictive of mortality when controlling for age, sex, and ISS (odds ratio 1.45, p value 0.028). The area under the receiver operating characteristic curve for GFAP was 0.90 for day 1 and 0.88 for day 2. A GFAP cutoff point of 1 pg/mL yielded 100% specificity and 50% to 60% sensitivity for TBI. Conclusions: GFAP is a serum marker of TBI, and persistent elevation on day 2 is predictive of increased mortality. Excellent specificity for CT-documented brain injury was found using a cutoff point of 1 pg/mL.
科研通智能强力驱动
Strongly Powered by AbleSci AI