The Utility of GFAP and UCHL-1 in Mild Traumatic Brain Injury

Introduction: Mild Traumatic Brain Injury (mTBI) affects millions of people worldwide each year and significantly impacts the healthcare system. Clinical criteria and computed tomography (CT) scans are used for diagnosis. The Glial Fibrillary Acidic Protein (GFAP), a protein present in glial cells, and the ubiquitin C-terminal hydrolase L1 (UCH-L1), localized in neurons, are biomarkers that have been approved to help determine the need for CT brain scans after traumatic brain injury. Methods: This study was performed in the emergency department of the Municipal Clinical Hospital of Timisoara, Romania. Inclusion criteria consisted of all patients with mTBI admitted for 3 months with a brain CT, over 18 years of age, and with a Glasgow Coma Scale score between 13 and 15 at admission. Biomarkers were collected within a maximum of 12 hours of trauma. Results: Of the 145 patients admitted with mTBI, 106 met the inclusion criteria, of whom 56 (52.83%) were men and 50 (47.17%) were women. Demographic characteristics between groups were similar. Males had a median age of 66 years [range 20-89], and female patients had the same 66 [range 19-94] (p = 0.986). The median for UCHL-1 (cut-off was 400 pg/ml) was 495.4 for females and 690.7 for males. For GFAP (cut-off was 35 pg/ml), there was a median of 60.9 for females and 58.3 for males. Higher values of these biomarkers were positively correlated with complications on brain CT (p < 0.001 for both). Conclusion: Male patients showed significantly higher concentrations of UCHL-1 than females. This study demonstrates that elevated values of the two biomarkers are correlated with specific lesions on CT scans after mTBI and may play an essential role in determining whether or not emergency CT scans should be performed.