Clin Chem Lab Med. 2025 Dec 17. doi: 10.1515/cclm-2025-1315. Online ahead of print.
ABSTRACT
OBJECTIVES: Prognostication in patients with severe acute brain injury (SABI) in the Intensive Care Unit (ICU) is complex, often requiring early decisions on life-sustaining therapy. Serum biomarkers such as neurofilament light (NFL), glial fibrillary acidic protein (GFAP) and neuron specific enolase (NSE) may aid in predicting outcomes. This study investigated the association between biomarker concentrations and hospital mortality in ICU patients with SABI.
METHODS: In this prospective multi-center study, 103 adult ICU patients with SABI were enrolled within 24 h of injury. Serum concentrations (NFL, GFAP, NSE) were measured at 24 h, 72 h, 7 days, and 14 days post-injury. Biomarker concentrations between hospital survivors and non-survivors were compared using a linear mixed-effects model and ROC curves.
RESULTS: GFAP concentrations peaked on day 1, while NSE and NFL concentrations peaked on day 14. Higher concentrations were observed in non-survivors for all biomarkers on day 3, a 1,4 fold increase for NSE (p=0.034) and approximately 2-fold increase for GFAP (p=0.041) and NFL (p=0.018). Distinct temporal patterns were observed for all biomarkers, although biomarker trajectories did not significantly differ between survivors and non-survivors. Prognostic accuracy was moderate when biomarkers were combined with established mortality predictors (AUC 0.749) on day 3.
CONCLUSIONS: NSE, GFAP and NFL show distinct temporal trajectories in SABI patients. Concentrations were higher in non-survivors during the early phase of admission. While individual biomarkers showed limited prognostic accuracy, in combination with other predictors mortality prediction improved. Serum biomarkers may still be valuable in a multimodal prognostication framework for SABI patients.
PMID:41400634 | DOI:10.1515/cclm-2025-1315