Minor head injury in anticoagulated patients: performance of biomarkers S100B, NSE, GFAP, UCH-L1 and Alinity TBI in the detection of intracranial injury. A prospective observational study

Vincenzo G Menditto; Marco Moretti; Lucia Babini; Annalisa Mattioli; Andres Ramon Giuliani; Marina Fratini; Fabienne Yvonne Pallua; Elisa Andreoli; Cinzia Nitti; Susanna Contucci; Armando Gabrielli; Marco Bruno Luigi Rocchi; Giovanni Pomponio

doi:10.1515/cclm-2023-1169

Minor head injury in anticoagulated patients: performance of biomarkers S100B, NSE, GFAP, UCH-L1 and Alinity TBI in the detection of intracranial injury. A prospective observational study

Clin Chem Lab Med. 2024 Jan 12. doi: 10.1515/cclm-2023-1169. Online ahead of print.

Affiliations

¹ Emergency and Internal Medicine Department, Azienda Ospedaliero Universitaria delle Marche, Ancona, Ancona, Italy.
² Medicina di Laboratorio, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy.
³ Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ancona, Italy.
⁴ Statistica Medica, Dipartimento di Scienze Biomolecolari, Università di Urbino, Urbino, Italy.
⁵ Clinica Medica, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy.

PMID: 38206121
DOI: 10.1515/cclm-2023-1169

Abstract

Objectives: Data in literature indicate that in patients suffering a minor head injury (MHI), biomarkers serum levels could be effective to predict the absence of intracranial injury (ICI) on head CT scan. Use of these biomarkers in case of patients taking oral anticoagulants who experience MHI is very limited. We investigated biomarkers as predictors of ICI in anticoagulated patients managed in an ED.

Methods: We conducted a single-cohort, prospective, observational study in an ED. Our structured clinical pathway included a first head CT scan, 24 h observation and a second CT scan. The outcome was delayed ICI (dICI), defined as ICI on the second CT scan after a first negative CT scan. We assessed the sensitivity (SE), specificity (SP), negative predictive value (NNV) and positive predictive value (PPV) of the biomarkers S100B, NSE, GFAP, UCH-L1 and Alinity TBI in order to identify dICI.

Results: Our study population was of 234 patients with a negative first CT scan who underwent a second CT scan. The rate of dICI was 4.7 %. The NPV for the detection of dICI were respectively (IC 95 %): S100B 92.7 % (86.0-96.8 %,); ubiquitin C-terminal hydrolase-L1 (UCH-L1) 91.8 % (83.8-96.6 %); glial fibrillary protein (GFP) 100 % (83.2-100 %); TBI 100 % (66.4-100 %). The AUC for the detection of dICI was 0.407 for S100B, 0.563 for neuron-specific enolase (NSE), 0.510 for UCH-L1 and 0.720 for glial fibrillary acidic protein (GFAP), respectively.

Conclusions: The NPV of the analyzed biomarkers were high and they potentially could limit the number of head CT scan for detecting dICI in anticoagulated patients suffering MHI. GFAP and Alinity TBI seem to be effective to rule out a dCI, but future trials are needed.

Keywords: anticoagulated patients; glial fibrillary acidic protein (GFAP); minor head injury; neuron-specific enolase (NSE); protein S100B; ubiquitin C-terminal hydrolase-L1 (UCHL-1).