Journal of Neurology Research, ISSN 1923-2845 print, 1923-2853 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Neurol Res and Elmer Press Inc
Journal website https://www.neurores.org

Original Article

Volume 15, Number 1, January 2025, pages 12-32

Role of Serum Biomarkers in the Assessment of Traumatic Brain Injury

Figures

↓  Figure 1. Glasgow coma scale.
Figure 1.
↓  Figure 2. Graphical representation of the main protein biomarkers of cranial trauma associated with different pathophysiological processes in cranial trauma.
Figure 2.
↓  Figure 3. Distribution of cranial injuries and severity of damage among the examined population.
Figure 3.
↓  Figure 4. Distribution of the studied population related to age.
Figure 4.
↓  Figure 5. Scatter plot of NSE test performance. NSE: neuron-specific enolase.
Figure 5.
↓  Figure 6. ROC curve related to NSE results. ROC: receiver operating characteristic; NSE: neuron-specific enolase.
Figure 6.
↓  Figure 7. Comparison of the performance of UCH-L1 and GFAP tests. GFAP: glial fibrillary acidic protein; UCH-L1: ubiquitin C-terminal hydrolase L1.
Figure 7.
↓  Figure 8. ROC curve for the performance of UCH-L1. ROC: receiver operating characteristic; UCH-L1: ubiquitin C-terminal hydrolase L1.
Figure 8.
↓  Figure 9. (a) ROC curve for the performance of GFAP. (b) ROC curve for the performance of GFAP with 100% sensitivity. GFAP: glial fibrillary acidic protein; ROC: receiver operating characteristic.
Figure 9.
↓  Figure 10. Scatter plot of S100 performance.
Figure 10.
↓  Figure 11. ROC curve relative to S100 performance. ROC: receiver operating characteristic.
Figure 11.
↓  Figure 12. Scatter plot of NFL performance. NFL: neurofilament light chain.
Figure 12.
↓  Figure 13. ROC curve relative to NFL performance. NFL: neurofilament light chain; ROC: receiver operating characteristic.
Figure 13.
↓  Figure 14. Comparison of the performance of the five dosed markers.
Figure 14.
↓  Figure 15. Comparison of ROC curves for the sensitivity attributed to the five dosed biomarkers. ROC: receiver operating characteristic.
Figure 15.

Tables

↓  Table 1. List of the 68 Total Cases of Traumatic Brain Injury Studied
 
Sample ID No. Glasgow coma scale Clinical information from radiological investigations
aMild trauma. bModerate trauma. cSevere trauma.
1 15a No evidence of traumatic intracranial lesions
2 15a No evidence of traumatic intracranial lesions
3 15a No evidence of traumatic intracranial lesions
4 15a No evidence of traumatic intracranial lesions
5 15a No evidence of traumatic intracranial lesions
6 15a No evidence of traumatic intracranial lesions
7 15a No evidence of traumatic intracranial lesions
8 15a Subarachnoid hemorrhage in the right central sulcus
9 14a No evidence of traumatic intracranial lesions
10 15a No evidence of traumatic intracranial lesions
11 15a No evidence of traumatic intracranial lesions
12 15a No evidence of traumatic intracranial lesions
13 15a No evidence of traumatic intracranial lesions
14 15a No evidence of traumatic intracranial lesions
15 15a No evidence of traumatic intracranial lesions
16 15a No evidence of traumatic intracranial lesions
17 15a No evidence of traumatic intracranial lesions
18 3c Bedside chest X-ray
19 3c Right frontotemporal insular intracerebral hemorrhage, mesencephalic compression, infrarenal aortic aneurysm
20 15a Temporal laceration-contusion outbreakes, subarachnoid hemorrhage
21 15a No evidence of traumatic intracranial lesions
22 15a No evidence of traumatic intracranial lesions
23 15a Hyperdense subcortical outbreakes, hyperdense subdural layer
24 15a No evidence of traumatic intracranial lesions
25 15a No evidence of traumatic intracranial lesions
26 12b Traces of subarachnoid hematoma in the right upper frontal sulcus, atheromatous changes in the aortic arch
27 15a Subarachnoid hemorrhage in right frontal convexity, large left parietal-occipital hematoma
28 13a No evidence of traumatic intracranial lesions
29 15a No evidence of traumatic intracranial lesions
30 15a No evidence of traumatic intracranial lesions
31 15a Intracranial hemorrhage, lacerated contusive focus of the right fronto-temporal parietal and left thalamic nerves, reduced thickness of the subdural layer, right fronto-temporal hyperdensity
32 15a No evidence of traumatic intracranial lesions
33 15a No evidence of traumatic intracranial lesions
34 15a No evidence of traumatic intracranial lesions
101 15a No evidence of traumatic intracranial lesions
102 15a No evidence of traumatic intracranial lesions
103 15a No evidence of traumatic intracranial lesions
104 15a No evidence of traumatic intracranial lesions
105 15a No evidence of traumatic intracranial lesions
106 15a No evidence of traumatic intracranial lesions
107 15a No evidence of traumatic intracranial lesions
108 15a No evidence of traumatic intracranial lesions
109 15a No evidence of traumatic intracranial lesions
110 15a Bilateral frontal subarachnoid hematoma, epicranial soft tissue hematoma
111 15a No evidence of traumatic intracranial lesions
112 15a No evidence of traumatic intracranial lesions
113 15a Frontal subgaleal hematoma, falx cerebri blood hyperdensity
114 8c Intraparenchymal capsulothalamic hemorrhage, subgaleal hematoma
115 15a Streaks of subarachnoid hematoma in the right precentral sulci and cortical blood foci
116 15a No evidence of traumatic intracranial lesions
117 9b Subarachnoid hemorrhage, intraparenchymal hemorrhagic area
118 15a No evidence of traumatic intracranial lesions
119 15a No evidence of traumatic intracranial lesions
120 15a No evidence of traumatic intracranial lesions
121 15a Ematoma subaracnoideo temporale e frontale, focolaio lacero-contusivo cerebellare sinistro
122 15a No evidence of traumatic intracranial lesions
123 15a No evidence of traumatic intracranial lesions
124 15a Subcortical lacerated contusive foci, frontotemporal subarachnoid hematoma
125 15a No evidence of traumatic intracranial lesions
126 15a Hyperdense areas of blood contusion right cortex, streaks of subarachnoid hematoma in the cerebrospinal fluid spaces
128 15a No evidence of traumatic intracranial lesions
129 14a No evidence of traumatic intracranial lesions
130 15a Subdural hematoma, subarachnoid hemorrhage
131 14a No evidence of traumatic intracranial lesions
132 15a Posterior fronto-mesial subarachnoid hematoma, subgaleal hematoma
133 15a Subdural hematoma, thin left median parafalcal blood layer
134 15a No evidence of traumatic intracranial lesions
135 15a No evidence of traumatic intracranial lesions

 

↓  Table 2. NSE Marker Results Associated With Acute Cranial Trauma
 
Sample ID No. NSE (mg/L) Severity of trauma
aPathological values. bValues measured as borderline close to the clinical cutoff (17 mg/L). cSevere or moderate severity of the trauma. NSE: neuron-specific enolase.
102 15.9 Mild
103 29.3a Mild
104 11.1 Mild
105 18.2a Mild
106 41.1a Mild
108 13.7 Mild
109 17.7b Mild
110 14.3 Mild
111 15.1 Mild
112 15.4 Mild
114 13.3 Severec
118 14.9 Mild
121 19.0a Mild
122 130.0a Mild
123 119.0a Mild
124 32.7a Mild
125 19.1a Mild
126 27.3a Mild
128 17.5b Mild
129 68.4a Mild
131 16.4 Mild
132 48.3a Mild
133 46.7a Mild
134 13.7 Mild

 

↓  Table 3. UCH-L1 Marker Results Associated With Traumatic Brain Injury
 
Sample ID No. UCH-L1 (pg/mL) Severity of trauma
aPathological values. bValues measured as borderline close to the clinical cutoff (400 pg/mL). cSevere or moderate severity of the trauma. UCH-L1: ubiquitin C-terminal hydrolase L1.
1 203.8 Mild
2 563.3a Mild
3 1,953.3a Mild
4 203.8 Mild
5 294.2 Mild
6 122.1 Mild
7 113.7 Mild
8 325.1 Mild
9 665.5a Mild
10 207.1 Mild
11 400.3b Mild
12 842a Mild
13 377.1 Mild
14 279.1 Mild
15 1,526.1a Mild
16 1,934.1a Mild
17 634.2a Mild
18 25,000.0a Severec
19 1,545.5a Severec
20 85.0 Mild
21 226.3 Mild
22 158.0 Mild
23 460.9a Mild
24 324.2 Mild
25 117.1 Mild
26 664.0a Moderatec
27 505.6a Mild
29 738.2a Mild
30 361.9 Mild
31 823.0a Mild
32 1,150.7a Mild
33 464.2a Mild
34 364.6 Mild
102 157.5 Mild
103 1,012.4a Mild
104 320.8 Mild
105 2,836.2a Mild
106 434.2a Mild
107 1,789.6a Mild
108 671.9a Mild
109 415.1a Mild
110 121.4 Mild
111 171.9 Mild
112 10,340.7a Mild
113 5,192.6a Mild
114 255.8 Severec
118 501.3a Mild
121 1,889.2a Mild
123 363.5 Mild
124 2,098.3a Mild
125 3,418.1a Mild
126 530.5a Mild
128 1,559.9a Mild
129 509.7a Mild
130 1,920.8a Mild
131 1,044.9a Mild
132 931.8a Mild
133 280.6 Mild
134 176.2 Mild

 

↓  Table 4. GFAP Marker Results Associated With Traumatic Brain Injury
 
Sample ID No. GFAP (pg/mL) Severity of trauma
aPathological values above the clinical cutoff (35 pg/mL). bSevere or moderate severity of the trauma. GFAP: glial fibrillary acidic protein.
1 195.6a Mild
2 42a Mild
3 171.8a Mild
4 37.3a Mild
5 59.5a Mild
6 30.1 Mild
7 223a Mild
8 497.9a Mild
9 99.4a Mild
10 16.9 Mild
11 192.8a Mild
12 25.1 Mild
13 70.9a Mild
14 77.6a Mild
15 304.7a Mild
16 28.6 Mild
17 15.1 Mild
18 976.9a Severeb
19 8,124.9a Severeb
20 140.2a Mild
21 102.2a Mild
22 374a Mild
23 1,204.5a Mild
24 40.6a Mild
25 11.3 Mild
26 148.3a Moderateb
27 39.6a Mild
29 113.6a Mild
30 29.5 Mild
31 8,527.2a Mild
32 26.1 Mild
33 71.9a Mild
34 114.5a Mild
102 4.4 Mild
103 14.9 Mild
104 76.5a Mild
105 37.9a Mild
106 227.4a Mild
107 27.6 Mild
108 370a Mild
109 99.4a Mild
110 301a Mild
111 15.8 Mild
112 144.4a Mild
113 90.3a Mild
114 2,937.5a Severeb
118 99.2a Mild
121 454.2a Mild
123 54.2a Mild
124 103.3a Mild
125 109.8a Mild
126 153.6a Mild
128 119.3a Mild
129 82.4a Mild
130 293.7a Mild
131 63a Mild
132 113.2a Mild
133 68.5a Mild
134 34.8 Mild

 

↓  Table 5. S100 Marker Results Associated With Acute Cranial Trauma
 
Sample ID No. S100 (mg/L) Severity of trauma
aPathological values above the clinical cutoff (0.15 µg/L). bSevere or moderate severity of the trauma. S100: calcium-binding protein of astroglial origin.
1 0.31a Mild
2 0.37a Mild
3 1.02a Mild
4 0.05 Mild
5 0.07 Mild
6 0.10 Mild
7 0.02 Mild
8 0.21a Mild
9 0.02 Mild
10 0.09 Mild
11 0.23a Mild
12 0.47a Mild
13 0.12 Mild
14 0.12 Mild
15 1.72a Mild
16 2.33a Mild
17 0.54a Mild
18 28.84a Severeb
19 2.09a Severeb
20 0.09 Mild
21 0.13 Mild
22 0.12 Mild
23 0.2a Mild
24 0.18a Mild
25 0.08 Mild
26 0.70a Moderateb
27 0.19a Mild
29 0.82a Mild
30 0.28a Mild
31 1.00a Mild
32 0.83a Mild
33 0.58a Mild
34 0.40a Mild
102 0.02 Mild
103 0.49a Mild
104 0.03 Mild
105 0.44a Mild
106 0.09 Mild
107 0.37a Mild
108 0.21a Mild
109 0.22a Mild
110 0.25a Mild
111 0.44a Mild
112 3.04a Mild
113 3.43a Mild
114 0.37a Severeb
118 0.07 Mild
121 1.81a Mild
123 0.26a Mild
124 1.62a Mild
125 0.09 Mild
126 0.22a Mild
128 0.83a Mild
129 0.58a Mild
130 0.82a Mild
131 0.55a Mild
132 0.19a Mild
133 0.39a Mild
134 0.06 Mild

 

↓  Table 6. Results Related to the NFL Marker Dosage
 
Sample ID No. NFL (pg/mL) Severity of trauma
aPathological values. bValues measured as borderline close to the clinical cutoff (21 pg/mL). cSevere or moderate severity of the trauma. NFL: neurofilament light chain.
1 26.06a Mild
2 19.31 Mild
3 24.49a Mild
4 36.17a Mild
5 45.16a Mild
6 12.07 Mild
7 25.11a Mild
8 22.39a Mild
9 263.77a Mild
10 14.75 Mild
11 130.01a Mild
12 13.85 Mild
13 81.28a Mild
14 63.88a Mild
15 47.43a Mild
16 30.94a Mild
17 12.68 Mild
18 109.50a Severec
19 111.49a Severec
20 27.98a Mild
21 29.09a Mild
22 8.15 Mild
23 22.71a Mild
24 9.24 Mild
25 6.75 Mild
26 28.30a Moderatec
27 60.54a Mild
29 46.17a Mild
30 27.92a Mild
31 72.45a Mild
32 7.92 Mild
33 16.85 Mild
34 20.03 Mild
102 11.14 Mild
103 15.15 Mild
104 76.03a Mild
105 21.66b Mild
106 228.70a Mild
107 75.05a Mild
108 36.50a Mild
109 8.76 Mild
110 10.80 Mild
111 4.88 Mild
112 13.10 Mild
113 24.11a Mild
114 38.81a Severec
116 26.59a Mild
117 79.50a Moderatec
118 15.47 Mild
119 42.00a Mild
120 9.95 Mild
121 23.20a Mild
123 28.76a Mild
124 9.90 Mild
125 113.89a Mild
126 30.29a Mild
128 78.76a Mild
129 176.69a Mild
130 28.25a Mild
131 23.52a Mild
132 68.07a Mild
133 837.72a Mild
134 13.08 Mild