550: PROGNOSTIC AND DIAGNOSTIC UTILITY OF SERUM BIOMARKERS IN PEDIATRIC TRAUMATIC BRAIN INJURY

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Introduction: This study aimed to determine if a serum biomarker panel can be used as a diagnostic and prognostic tool in pediatric Traumatic Brain Injury (pTBI). Methods: Prospective, observational study that collected and analyzed brain injury biomarkers at enrollment, 24- and 48-hours post-injury in 34 children ages 0-18 with TBI and 19 healthy controls (HC). Biomarkers included Glial Fibrillary Acidic Protein (GFAP), Neurofilament Protein L (NfL), Ubiquitin-C-terminal Hydrolase (UCHL1), S100B, tau, and p-tau181. Subjects were stratified by admission GCS score into two categories: Mild/moderate (GCS 9-15) and severe (GCS 3-8). Glasgow Outcome Scale-Extended (GOS-E Peds) was assessed at 2-6 weeks, 6-9 months, and 12 months post-injury. GOS-E Peds was dichotomized into unfavorable (5-8) and favorable (1-4) outcomes. Data were analyzed utilizing Prism 9 software. Results: All biomarkers measured at enrollment across injury severity were elevated compared to HC (p-value < 0.05), with an AUC of 0.82 for GFAP, 0.74 for NfL, 0.78 for UCHL1, 0.82 for S100B, 0.83 for tau and 0.91 for p-tau. Levels of GFAP, NfL, UCHL1, and tau were elevated compared to HC at 24h, with an AUC of 0.83 for GFAP, 0.99 for NfL, 0.83 for UCHL1, and 0.87 for tau. NfL, S100B, and p-tau demonstrated an increased serum value in contrast to HC at 48h, with an AUC of 0.89 for NfL, 0.97 for S100B, and 0.91 for p-tau. GFAP, tau, and p-tau demonstrated the ability to differentiate TBI severity in the mild/moderate group when measured at enrollment (p-value 0.008, 0.017, and 0.0018, respectively) with an AUC of 0.83 for GFAP, 0.84 for tau and 0.87 for p-tau. In addition NfL and p-tau could differentiate severity at 48 h versus HC (p-value 0.0499, 0.0311) with an AUC of 0.81 for NfL and 0.93 for p-tau. When biomarkers were measured at enrollment, p-tau levels correlated with outcome prediction at 2-6 weeks with an AUC 0.90, UCHL1 at 6-9 months with an AUC 0.8, and at 12 months with an AUC 0.95. Moreover, NfL, tau, and S100B levels correlated with unfavorable outcomes at 12 months with AUC’S of 0.84, 1, and 0.95, respectively. Conclusions: During the first 0-48 hours following pTBI, a serum biomarker panel that measures different pathomechanistic insults could aid in the early diagnosis of mild pTBI and may predict neurological outcomes.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.