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The diagnostic and prognostic value of glial fibrillary acidic protein in traumatic brain injury: a systematic review and meta-analysis

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Objectives

Over the years, blood biomarkers have been extensively applied for diagnostic and prognostic assessment of traumatic brain injury (TBI). Herein, we conducted a meta-analysis to evaluate the diagnostic and prognostic value of glial fibrillary acidic protein (GFAP) for TBI patients.

Methods

The online databases, including PubMed, Embase, Cochrane Library, CNKI, and WFSD, were systematically retrieved from inception until May 2021. The RevMan 5.3 software and Stata 15 were used to conduct data analysis.

Results

A total of 22 eligible studies comprising 3709 patients were included in this meta-analysis. The pooled results indicated that serum GFAP had a diagnostic value in detecting traumatic intracranial lesions (AUC 0.81; 95% CI 0.77–0.84; p < 0.00001). The pooled sensitivity and specificity were 0.93 (95% CI 0.81–0.98), and 0.66 (95% 0.53–0.77; p < 0.00001), respectively. For assessment of unfavorable outcome, the pooled sensitivity, specificity and AUC value were 0.66 (95% CI 0.54–0.76; p < 0.00001), 0.82(95% CI 0.72–0.90; p < 0.00001), and 0.82 (95% CI 0.76–0.88; p < 0.00001), respectively. Besides, GFAP exhibited a significant value in predicting mortality (AUC 0.81; 95% CI 0.77–0.84; p < 0.00001), with high sensitivity and specificity (0.86, 95% CI 0.79–0.92, p < 0.00001, and 0.66, 95% CI 0.52–0.77, p < 0.00001). The subgroup analysis indicated that the type of TBI and cut-off value were potential sources of heterogeneity, which influenced the pooled AUC values for mortality prediction.

Conclusions

Our meta-analysis indicated that GFAP had diagnostic and prognostic value for TBI patients, especially during the early TBI.

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Acknowledgements

The authors would like to thank the “European Journal of Trauma and Emergency Surgery” for providing such an excellent academic platform.

Funding

This study was supported by the Hospital Level Support Projects (Fcjs202050); the Jiangsu Key Laboratory of Experimental & Translational Non-coding RNA Research (201902).

Author information

Authors and Affiliations

  1. Department of Clinical Medicine, Dalian Medical University, Dalian, Liaoning, China

    Yunlong Pei, Enpeng Zhang & Kongye Lu

  2. Department of Neurosurgery, Clinical Medical College of Yangzhou University, No.98 Nantong Westroad, Yangzhou, 225001, Jiangsu, China

    Yunlong Pei, Enpeng Zhang, Yujia Huang, HengZhu Zhang & Lun Dong

  3. Department of Rehabilitation, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu, China

    Xiaojia Tang

  4. Department of Emergency, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China

    Boming Xia

  5. Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China

    Jun Zhang

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  1. Yunlong Pei
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Correspondence to Lun Dong.

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Supplementary Information

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Supplementary file1 (TIF 635 kb) Risk of bias and applicability concerns summary for each included study

68_2022_1979_MOESM2_ESM.tif

Supplementary file2 (TIF 106 kb) The funnel plot of DEEK`s funnel plot for pooled sensitivity and specificity in detecting traumatic intracranial lesions, assessing unfavorable outcome, and predicting mortality (a, b, and c); funnel plot for pooled AUC value in detecting traumatic intracranial lesions, assessing unfavorable outcome, and predicting mortality (d, e, and f)

Supplementary file3 (TIF 99 kb)

Supplementary file4 (TIF 89 kb)

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Supplementary file7 (TIF 99 kb)

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Pei, Y., Tang, X., Zhang, E. et al. The diagnostic and prognostic value of glial fibrillary acidic protein in traumatic brain injury: a systematic review and meta-analysis. Eur J Trauma Emerg Surg 49, 1235–1246 (2023). https://doi.org/10.1007/s00068-022-01979-y

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  • DOI: https://doi.org/10.1007/s00068-022-01979-y

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