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Brain injury biomarkers as outcome predictors in pediatric severe traumatic brain injury
Hani Daoud1, Ibrahim Alharfi, Ibrahim Alhelali
1Department of Paediatrics, Western University, London, ON, Canada.
Insights
Biomarkers in cerebrospinal fluid and blood show promise for predicting outcomes in pediatric severe traumatic brain injury (sTBI). Further research is needed for novel biomarker discovery and validation in large studies.
Area of Science:
- Neuroscience
- Biomarker Research
- Pediatric Traumatology
Background:
- Severe traumatic brain injury (sTBI) in children poses significant challenges for outcome prediction.
- Identifying reliable biomarkers in cerebrospinal fluid (CSF) and blood is crucial for assessing injury severity and prognosis.
- Existing literature on brain injury biomarkers in pediatric sTBI requires systematic evaluation.
Purpose of the Study:
- To systematically review and synthesize the literature on brain injury biomarkers.
- To determine the predictive value of CSF and blood biomarkers for outcomes in pediatric sTBI.
- To identify promising biomarkers for future research and clinical application.
Main Methods:
- Comprehensive literature search across multiple databases (MEDLINE, EMBASE, PsycINFO, Pubmed, Cochrane) and grey literature.
- Inclusion of studies with no language, publication type, or date restrictions.
- Independent critical review of all identified articles by two clinicians.
Main Results:
- 16 studies reviewed, examining 18 biomarkers (11 in CSF, 7 in blood).
- Significant correlations found between CSF biomarkers (e.g., IL-6, S100β, NSE) and blood biomarkers (e.g., GFAP, NF-H) with pediatric sTBI outcomes.
- Mixed or no correlations observed for certain biomarkers (e.g., blood S100β, CSF BDNF).
Conclusions:
- Current research highlights potential for specific CSF and blood biomarkers in predicting pediatric sTBI outcomes.
- Further research should focus on discovering novel biomarkers.
- Validation of biomarker panels in large, well-designed longitudinal studies is essential.
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.
