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dc.contributor.authorCzeiter, Endre
dc.contributor.authorAmrein, Krisztina
dc.contributor.authorGravesteijn, BY
dc.contributor.authorLecky, Fiona
dc.contributor.authorMenon, David K
dc.contributor.authorMondello, Stefania
dc.contributor.authorNewcombe, Virginia F
dc.contributor.authorRichter, Sophie
dc.contributor.authorSteyerberg, Ewout W
dc.contributor.authorVande Vyvere, Thijs
dc.contributor.authorVerheyden, Jan
dc.contributor.authorXu, Haiyan
dc.contributor.authorYang, Zhihui
dc.contributor.authorMaas, Andrew I.R.
dc.contributor.authorWang, Kevin KW
dc.contributor.authorBuki, Andras
dc.contributor.authorAndelic, Nada
dc.contributor.authorAndreassen, Lasse
dc.contributor.authorAnke, Audny
dc.contributor.authorFrisvold, Shirin
dc.contributor.authorHelseth, Eirik
dc.contributor.authorRøe, Cecilie
dc.contributor.authorRøise, Olav
dc.contributor.authorSkandsen, Toril
dc.contributor.authorVik, Anne
dc.contributor.authorÅkerlund, Cecilia
dc.contributor.authorAntoni, Anna
dc.contributor.authorAudibert, Gerard
dc.contributor.authorAzouvi, Philippe
dc.contributor.authorAzzolini, Maria Luisa
dc.contributor.authorBartels, Ronald
dc.contributor.authorBarzo, Pal
dc.contributor.authorBeauvais, Romuald
dc.contributor.authorBeer, Ronny
dc.contributor.authorBellander, Bo-Michael
dc.contributor.authorBelli, Antonio
dc.contributor.authorBenali, Habib
dc.contributor.authorBerardino, Maurizio
dc.contributor.authorBeretta, Luigi
dc.contributor.authorBlaabjerg, Morten
dc.contributor.authorBragge, Peter
dc.contributor.authorBrazinova, Alexandra
dc.contributor.authorBrinck, Vibeke
dc.contributor.authorBrooker, Joanne
dc.contributor.authorBrorsson, Camilla
dc.contributor.authorBullinger, Monika
dc.contributor.authorCabeleira, Manuel
dc.contributor.authorCaccioppola, Alessio
dc.contributor.authorCalappi, Emiliana
dc.contributor.authorCalvi, Maria Rosa
dc.description.abstractBackground: Serum biomarkers may inform and improve care in traumatic brain injury (TBI). We aimed to correlate serum biomarkers with clinical severity, care path and imaging abnormalities in TBI, and explore their incremental value over clinical characteristics in predicting computed tomographic (CT) abnormalities. Methods: We analyzed six serum biomarkers (S100B, NSE, GFAP, UCH-L1, NFL and t-tau) obtained <24 h post-injury from 2867 patients with any severity of TBI in the Collaborative European NeuroTrauma Effectiveness Research (CENTER-TBI) Core Study, a prospective, multicenter, cohort study. Univariable and multivariable logistic regression analyses were performed. Discrimination was assessed by the area under the receiver operating characteristic curve (AUC) with 95% confidence intervals. Findings: All biomarkers scaled with clinical severity and care path (ER only, ward admission, or ICU), and with presence of CT abnormalities. GFAP achieved the highest discrimination for predicting CT abnormalities (AUC 0•89 [95%CI: 0•87-0•90]), with a 99% likelihood of better discriminating CT-positive patients than clinical characteristics used in contemporary decision rules. In patients with mild TBI, GFAP also showed incremental diagnostic value: discrimination increased from 0•84 [95%CI: 0•83-0•86] to 0•89 [95%CI: 0•87-0•90] when GFAP was included. Results were consistent across strata, and injury severity. Combinations of biomarkers did not improve discrimination compared to GFAP alone. Interpretation: Currently available biomarkers reflect injury severity, and serum GFAP, measured within 24 h after injury, outperforms clinical characteristics in predicting CT abnormalities. Our results support the further development of serum GFAP assays towards implementation in clinical practice, for which robust clinical assay platforms are required.en_US
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 Internasjonal*
dc.titleBlood biomarkers on admission in acute traumatic brain injury: Relations to severity, CT findings and care path in the CENTER-TBI studyen_US
dc.typePeer revieweden_US
dc.typeJournal articleen_US
dc.description.localcode2352-3964/© 2020 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license. (

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Attribution-NonCommercial-NoDerivatives 4.0 Internasjonal
Except where otherwise noted, this item's license is described as Attribution-NonCommercial-NoDerivatives 4.0 Internasjonal