Startseite Minor head injury in anticoagulated patients: performance of biomarkers S100B, NSE, GFAP, UCH-L1 and Alinity TBI in the detection of intracranial injury. A prospective observational study
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Minor head injury in anticoagulated patients: performance of biomarkers S100B, NSE, GFAP, UCH-L1 and Alinity TBI in the detection of intracranial injury. A prospective observational study

  • Vincenzo G. Menditto ORCID logo EMAIL logo , Marco Moretti , Lucia Babini , Annalisa Mattioli , Andres Ramon Giuliani , Marina Fratini , Fabienne Yvonne Pallua , Elisa Andreoli , Cinzia Nitti , Susanna Contucci , Armando Gabrielli , Marco Bruno Luigi Rocchi und Giovanni Pomponio
Veröffentlicht/Copyright: 12. Januar 2024
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Clinical Chemistry and Laboratory Medicine (CCLM)
Aus der Zeitschrift Clinical Chemistry and Laboratory Medicine (CCLM) Band 62 Heft 7

Abstract

Objectives

Data in literature indicate that in patients suffering a minor head injury (MHI), biomarkers serum levels could be effective to predict the absence of intracranial injury (ICI) on head CT scan. Use of these biomarkers in case of patients taking oral anticoagulants who experience MHI is very limited. We investigated biomarkers as predictors of ICI in anticoagulated patients managed in an ED.

Methods

We conducted a single-cohort, prospective, observational study in an ED. Our structured clinical pathway included a first head CT scan, 24 h observation and a second CT scan. The outcome was delayed ICI (dICI), defined as ICI on the second CT scan after a first negative CT scan. We assessed the sensitivity (SE), specificity (SP), negative predictive value (NNV) and positive predictive value (PPV) of the biomarkers S100B, NSE, GFAP, UCH-L1 and Alinity TBI in order to identify dICI.

Results

Our study population was of 234 patients with a negative first CT scan who underwent a second CT scan. The rate of dICI was 4.7 %. The NPV for the detection of dICI were respectively (IC 95 %): S100B 92.7 % (86.0–96.8 %,); ubiquitin C-terminal hydrolase-L1 (UCH-L1) 91.8 % (83.8–96.6 %); glial fibrillary protein (GFP) 100 % (83.2–100 %); TBI 100 % (66.4–100 %). The AUC for the detection of dICI was 0.407 for S100B, 0.563 for neuron-specific enolase (NSE), 0.510 for UCH-L1 and 0.720 for glial fibrillary acidic protein (GFAP), respectively.

Conclusions

The NPV of the analyzed biomarkers were high and they potentially could limit the number of head CT scan for detecting dICI in anticoagulated patients suffering MHI. GFAP and Alinity TBI seem to be effective to rule out a dCI, but future trials are needed.

Keywords: minor head injury; protein S100B; neuron-specific enolase (NSE); ubiquitin C-terminal hydrolase-L1 (UCHL-1); glial fibrillary acidic protein (GFAP); anticoagulated patients
Corresponding author: Vincenzo G. Menditto, MD, Emergency and Internal Medicine Department, Azienda Ospedaliero Universitaria delle Marche, Via Conca n.71, 60126 Ancona, Ancona, Italy, E-mail:

  1. Research ethics: The study protocol was approved by the local Ethics Committee (Ethics Committee for Clinical Trials, Ancona, Italy, #2018-41). The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013).

  2. Informed consent: Informed consent was obtained from all individuals included in this study, or their legal guardians or wards.

  3. Author contributions: The authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  4. Competing interests: The authors state no conflict of interest.

  5. Research funding: None declared.

  6. Data availability: The raw data can be obtained on request from the corresponding author.

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Received: 2023-10-18
Accepted: 2023-12-26
Published Online: 2024-01-12
Published in Print: 2024-06-25

© 2024 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/cclm-2023-1169
Schlagwörter für diesen Artikel
minor head injury; protein S100B; neuron-specific enolase (NSE); ubiquitin C-terminal hydrolase-L1 (UCHL-1); glial fibrillary acidic protein (GFAP); anticoagulated patients

Artikel in diesem Heft

  1. Frontmatter
  2. Editorial
  3. LC-MS/MS random access automation – a game changer for the 24/7 clinical laboratory
  4. Reviews
  5. Neurofilament light protein as a biomarker for spinal muscular atrophy: a review and reference ranges
  6. Differential diagnosis of ascites: etiologies, ascitic fluid analysis, diagnostic algorithm
  7. Opinion Papers
  8. Clinical Decision Support System in laboratory medicine
  9. Blood over-testing: impact, ethical issues and mitigating actions
  10. General Clinical Chemistry and Laboratory Medicine
  11. An isotope dilution-liquid chromatography-tandem mass spectrometry (ID-LC-MS/MS)-based candidate reference measurement procedure for the quantification of zonisamide in human serum and plasma
  12. An isotope dilution-liquid chromatography-tandem mass spectrometry (ID-LC-MS/MS)-based candidate reference measurement procedure for the quantification of carbamazepine in human serum and plasma
  13. An isotope dilution-liquid chromatography-tandem mass spectrometry (ID-LC-MS/MS)-based candidate reference measurement procedure (RMP) for the quantification of phenobarbital in human serum and plasma
  14. An isotope dilution-liquid chromatography-tandem mass spectrometry (ID-LC-MS/MS)-based candidate reference measurement procedure (RMP) for the quantification of primidone in human serum and plasma
  15. An isotope dilution-liquid chromatography-tandem mass spectrometry (ID-LC-MS/MS)-based candidate reference measurement procedure for the quantification of carbamazepine-10,11-epoxide in human serum and plasma
  16. Should we depend on reference intervals from manufacturer package inserts? Comparing TSH and FT4 reference intervals from four manufacturers with results from modern indirect methods and the direct method
  17. Comparison of three chatbots as an assistant for problem-solving in clinical laboratory
  18. Evidence-based cutoffs for total and adjusted calcium: a major factor in detecting severe hypo- and hypercalcemia
  19. Minor head injury in anticoagulated patients: performance of biomarkers S100B, NSE, GFAP, UCH-L1 and Alinity TBI in the detection of intracranial injury. A prospective observational study
  20. A comparative evaluation of the analytical performances of premier resolution-high-performance liquid chromatography (PR-HPLC) with capillary zone electrophoresis (CZE) assays for the detection of hemoglobin variants and the quantitation of HbA0, A2, E, and F
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  25. An automatic analysis and quality assurance method for lymphocyte subset identification
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  27. Machine learning-based delta check method for detecting misidentification errors in tumor marker tests
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