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Brain Injury Biomarkers as Outcome Predictors in Pediatric Severe Traumatic Brain Injury

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Abstract

Background

To systematically review the literature on brain injury biomarkers, defined as any injury biomarker detected in cerebrospinal fluid (CSF) or blood injury biomarkers primarily expressed in the brain parenchyma, to determine outcome prediction in pediatric severe traumatic brain injury (sTBI).

Methods

A search of MEDLINE®, EMBASE®, PsycINFO®, Pubmed®, and the Cochrane Database, as well as grey literature sources, personal contacts, hand searches, and reference lists. The search terms used were traumatic brain injury, biomarkers, prognosis, and children. No language, publication type, or publication date restrictions were imposed. All articles were critically reviewed by two clinicians independently.

Results

A total of 7,150 articles were identified initially with 16 studies identified for review. Eighteen different biomarkers were examined; 11 in CSF and 7 in blood. Outcomes assessed included either in-hospital mortality or functional state (hospital discharge, 3-months or 6-months; Glasgow Outcome Scale or Pediatric Cerebral Performance Category). Significant correlations were established between sTBI outcomes and various biomarkers in CSF (IL-6, IL-8, IL-1β, S100β, NGF, NSE, DCX, ET-1, HMGB-1, cytochrome C) and blood (GFAP, NF-H, UCH-L1, SBDP-145, leptin). Mixed results were obtained for blood S100β. Outcome did not correlate with several biomarkers in either CSF (BDNF, GDNF, α-Syn) or blood (NSE, MBP). The Class of Evidence was considered II in 1 study and III in the remaining 15 studies.

Conclusions

Based on the status of current sTBI biomarker research, we recommend that future research should be directed at both novel biomarker discovery and validation of biomarker panels in large, well-designed longitudinal studies.

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Acknowledgments

We thank Ms. Shauna Konrad, London Health Sciences Centre librarian, for the assistance with Database searches.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Paediatrics, Western University, London, ON, Canada

    Hani Daoud, Ibrahim Alharfi, Ibrahim Alhelali, Hadiah Qasem & Douglas D. Fraser

  2. Department of Pediatric Critical Care, King Fahad Medical City, Riyadh, Saudi Arabia

    Ibrahim Alharfi

  3. Department of Surgery, Western University, London, ON, Canada

    Tanya Charyk Stewart

  4. Trauma Program, London Health Sciences Center, London, ON, Canada

    Tanya Charyk Stewart & Douglas D. Fraser

  5. Translational Research Centre, London, ON, Canada

    Douglas D. Fraser

  6. Children’s Health Research Institute, London, ON, Canada

    Douglas D. Fraser

  7. Physiology and Pharmacology, Western University, London, ON, Canada

    Douglas D. Fraser

  8. Clinical Neurological Sciences, Western University, London, ON, Canada

    Douglas D. Fraser

  9. Pediatric Critical Care Medicine, Room C2-C82, Children’s Hospital, London Health Sciences Centre, 800 Commissioners Road East, London, ON, N6A 5W9, Canada

    Douglas D. Fraser

Authors
  1. Hani Daoud
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  2. Ibrahim Alharfi
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  3. Ibrahim Alhelali
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  4. Tanya Charyk Stewart
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  5. Hadiah Qasem
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  6. Douglas D. Fraser
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Corresponding author

Correspondence to Douglas D. Fraser.

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Daoud, H., Alharfi, I., Alhelali, I. et al. Brain Injury Biomarkers as Outcome Predictors in Pediatric Severe Traumatic Brain Injury. Neurocrit Care 20, 427–435 (2014). https://doi.org/10.1007/s12028-013-9879-1

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  • DOI: https://doi.org/10.1007/s12028-013-9879-1

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