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GFAP: Marker of Brain Injury in Acute Mild TBI

Neurology; ePub 2018 Sept 12; Gill, Latour, et al

A recent study confirms glial fibrillary acidic protein (GFAP) as a promising marker of brain injury in patients with acute mild traumatic brain injury (mTBI). A combination of various biomarkers linked to different pathophysiologic mechanisms increases diagnostic subgroup accuracy. Study participants presented to the emergency department with suspected mTBI (n=277) with a CT and MRI scan and healthy controls (n=49). Plasma concentrations of tau, GFAP, ubiquitin carboxyl-terminal hydrolase L1, and neurofilament light chain (NFL) were measured using the single-molecule array technology. Researchers found:

  • Concentrations of GFAP, tau, and NFL were higher in patients with mTBI, compared with those of controls.
  • GFAP yielded an area under the curve (AUC) of 0.93, confirming its discriminatory power for distinguishing mTBI from controls.
  • Levels of GFAP, tau, and NFL were higher in patients with trauma-related intracranial findings on CT compared with those with normal CT, with the only significant predictor being GFAP (AUC 0.77).
  • Among patients with mTBI, tau, NFL, and GFAP differentiated subjects with and without MRI abnormalities with an AUC of 0.83, with GFAP being the strongest predictor.

Gill J, Latour L, Diaz-Arrastia R, et al. Glial fibrillary acidic protein elevations relate to neuroimaging abnormalities acutely following a mild traumatic brain injury. [Published online ahead of print September 12, 2018]. Neurology. doi:10.1212/WNL.0000000000006321.